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brief description on mania

brief description on mania



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Mania Mania Presentation Transcript

  • MANIA Dr Madhura.T.K.
  •  Definition: Distinct period during which there is abnormally persisting elevated, expansive or irritable mood.Mood disorders – syndrome, with cluster of signs & symptoms
  • Common underlying characteristics• Elevated mood• Increase in quantity & speed of physical & mental activity
  • Clinical featuresMOOD:Elevated, feels on the top of the worldFeeling of intense well beingIrritability, outbursts of unprovoked anger:
  • IMPAIRMENTS IN (N) FUNCTIONING: Excess energy, tiredness & exhaustion Over activity: ^ level of motor activity actions – hurried & clumpsy Conduct & behavior: lot of attention colorful clothes, lack of social inhibition- abrasive, over familiar & outspoken, reckless spending of money
  • Cont….. Bodily sym. ^ appetite decreased need for sleep ^sexual need
  •  IMPACT ON PSYCHOLOGICAL FUNCTIONS: Thinking: Acceleration of speed Flight of ideas Flowery language DD: schizophrenia, Delusions : Grandiose Persecutory
  • 4 subtypes by ICD-10, Hypomania Mania without psychotic symptoms Mania with psychotic symptoms Manic episodes, unspecified
  • 1.Hypomania:Lesser degree of maniaSymptoms as that of mania, but never leads to disruption of work or social rejectionDiagnostic guide lines: ^ mood & ^ activity- several daysConsiderable interference with work/ social activity is consistent with hypomania.DD: Hyperthyroidism Anorexia nervosa Agitated depression Severe obsessional symptoms
  • 2.Mania without psychotic symptoms^mood, uncontrollable excitement with ^energy overactivity pressure of speech decreased need for sleep loss of social inhibitions unsustained attention marked distractibility grandiosity
  • Cont…. Perceptual ideas: appreciation of color Preoccupation with fine details of surfaces Subjective hyperacusis Mood : irritable & suspiciousFirst attack: 15- 30 yrsDiagnostic guide lines: sym – 1wk disruption of ordinary & social activities mood change + ^ energy
  • 3.Mania with psychotic symptoms Severe form of mania Inflated self esteem, grandiose ideas, delusions, irritability, suspiciousness into delusions of persecution, SEVERE CASES : grandiosity mood: incongruent neutral delusions/hallucinationsDD: schizophrenia4.Maniac episodes , unspecified.
  • DIAGNOSTIC GUIDELINESICD-10^moodUndue optimismExcessive energyOver activityDecreased need for sleepInflated self esteem, grandiosityExtravagance in spendingPressure of speechEpisode- 1wk, severe enough to disrupt work 7 social activities
  • DSM-IV Distinct period of abnormality, persistently elevated mood, expansive, irritable Mood disturbance with 3 or more sym Symptom do not meet the criteria for a mixed episode Mood disturbance is sufficiently severe to cause marked impairment in occupational functioning Symptom are not due to direct physiological effects of a substance or general medical condition
  • TREATMENT Maniac episodes: antipsychotics mood stabiliser olanzapine parenteral antipsychotics
  • DRUGS LITHIUM:Main stay of Rx – acute mania prophylactic agent600-900mg/day, initiallyTR 0.5- 1mEq/lMonitor for hypothyroidism
  •  SODIUM VALPROATE: TR 50 – 100 mcg/ml 20mg/day in divided dosesSE: thrombocytopenia ^ transaminase levelsPre Rx: CBC LFT
  •  CARBAMAZEPINE: 400-600mg/dayTR: 4-12mcg/lSE: SJ syndromePre Rx : CBC LFTEnzyme inducer, lowers blood levels of haloperidol
  •  LAMOTRIGINE: Adv. Doesn’t require blood level monitoringDose 25mg/day X 2wksIncremental doses, 25mg further
  •  TOPIRAMATE:Unique feature- wt loss25-50mg/day can be given upto 200-300mg/day
  • REFERENCES: J.N.Vyas-Essentials of post-graduate psychiatry Namboodri-Concise text book of Psychiatry DSM-IV, Diagnostic manual ICD-10, Diagnostic manual Niraj Ahuja- Concise text book of Psychiatry Eapen- Essentials of Psychiatry