Mania refers to a syndrome in which the central features are over-activity, mood changes, self-important ideas. This disorder lasting usually 3-4 months, followed by complete recovery.

1. PRESENTED BY:-
CHANCHAL
(BSN 3RD YEAR)
MANIC EPISODE (
F30)

2. DEFINITION
 Mania refers to a
syndrome in which the
central features are over-
activity, mood changes,
self-important ideas.
 This disorder lasting usually
3-4 months, followed by
complete recovery.

3. CLASSIFICATION OF MANIA
(ICD10)
F30 : Manic episode
F30.0 : Hypomania
F30.1 : Mania without psychotic symptoms
F30.2 : Mania with psychotic symptoms
F30.8 : Other manic episodes
F30.9 : Manic episodes unspecified

4. ETIOLOGY
1. Neurotransmitter and structural hypotheses :
:- r/t excessive level of nor-epinephrine and dopamine
:- r/t an imbalance b/w cholinergic and non-adrenergic systems or
:- r/t deficiency in serotonin.
:- biological findings suggests that lesions are more common in this
population in areas of the brain.
2. Genetic Considerations:
:- 1st degree relatives = 5-10% chance
:- Identical twins with bipolar disorders = ~ 40-70% chance.
3. Psychodynamic Theories:
:-Developmental Theorists hypothesized hat faulty family dynamics
during early life are responsible for manic behaviour in later life.
:- Psychodynamic hypothesis explains manic episodes as a defense
against or denial of depression.

5. PSYCHOPATHOLOGY
 Manic state shows lack of inhibition, apparent
quickness of psychological reactions,
distractibility, and flight of ideas.
 Abraham believed that the manic episodes may
reflect an inability to tolerate a developmental
tragedy(such as loss of parents)
 Klein viewed mania as a defence reaction to
depression.

6. CLINICAL FEATURES
 Elevated, Expansive or Irritable Mood :-
 Elevated mood in mania has four stages depending on the severity
of manic episodes:
1) Euphoria (Stage I):Increased sense of psychological well-being
and happiness not in keeping with ongoing events.
2) Elation (Stage II):Moderate elevation of mood with increased
psychomotor activity.
3) Exaltation(Stage III):Intense elevation of mood with delusions
of grandeur.
4) Ecstasy (Stage IV):Severe elevation of mood, intense sense of
rapture or blissfulness seen in delirious or stuporous mania.
 Expansive mood is unceasing and unselective enthusiasm for
interacting with people and surrounding environment.
 Irritable mood may be predominant, especially when the person is
stopped from doing what he wants. There may be rapid, short-lasting
shifts from euphoria to depression or anger.

7.  Psychomotor Activity
There is an increased psychomotor activity ranging
from over activeness and restlessness to manic
excitement. The person involves in cease-less
activity. These activities are goal-oriented and
based on external environment cues.
 Speech and Thought
Flight of ideas: Thoughts racing in mind, rapid shifts
from one topic to another
Pressure of speech: Speech is forceful, strong and
difficult to interrupt. Uses playful language with
punning, rhyming, joking and teasing and speaks
loudly
Delusions of grandeur
Delusions of persecution
Distractibility

8.  Other Features
 Increased sociabilities
 Impulsive behavior
 Disinhibition
 Hypersexual and promiscuous behavior
 Poor judgment
 High-risk activities (buying sprees, reckless driving,
foolish business investments, distributing money or
articles to unknown persons)
 Dressed up in gaudy and flamboyant clothes although in
severe mania there may be poor self-care
 Decreased need for sleep (< 3hrs)
 Decreased food intake due to over-activity
 Decreased attention and concentration
 Absent insight

9. DIAGNOSIS
 Psychological tests such as Young Mania
Rating Scale
 ICD10 diagnostic criteria
 Based on S/S

10. TREATMENT MODALITIES
1. Pharmacotherapy
i. Lithium : 900-2100mg/day
ii. Carbamazepine : 600-1800mg/day
iii. Sodium Valporate : 600-2600mg/day
iv. Lamotrigine : 25-200mg/day
v. Other drugs : Clonazepam, Calcium channel
Blocker, etc.
2. Electroconvulsive Therapy (ECT)
3. Psychosocial Treatment
i. Family & Marital Therapy

11. NURSING MANAGEMENT OF
MANIA
NURSING DIAGNOSIS:
1. High risk for injury r/t extreme hyperactivity and impulsive
behaviour, evidenced by lack of control over purposeless and
potentially injurious movements.
2. High risk for violence; self directed or directed to others r/t
manic excitement, delusional thinking and hallucinations.
3. Imbalanced nutrition, less than body requirements r/t refusal or
inability to sit still long enough to eat, evidenced by weight
loss, amenorrhea.
4. Impaired social interaction r/t egocentric and narcissistic,
evidenced by inability to develop satisfying relationships and
manipulation of others for own desires.
5. Self-esteem disturbance r/t unmet dependency needs, lack of
positive feedback, unrealistic self-expectations.
6. Interuppted family process r/t euphoric-mood and grandiose
ideas, manipulative behaviour, refusal to accept responsibility
for own actions.

12. Nursing interventions for hyperactive behaviour
Interventions Rationale
(a)Keep environmental stimuli to a
minimum; assign single room;
limit interactions with others; keep
lighting and noise level low. Keep
his room and immediate
environment minimally furnished.
(b) Remove hazardous objects and
substances, caution the patient
when there is possibility of an
accident.
(c) Assist patient to engage in
activities, such as writing, drawing
and other physical exercise.
(d)Stay with patient as hyperactivity
increases.
(e)Administer medication as
prescribed by physician.
Patient is extremely distractible and
responds to even the slightest
stimuli.
Rationality is impaired and patient
may harm self inadvertently.
To bring relief from pent-up tension
and dissipate energy.
To offer support and provide feeling
of security.
For providing rapid relief from
symptoms of hyperactivity.

13. Nursing interventions for manic violent behaviour
Interventions Rationale
(a) Maintain low level of stimuli in
patient's environment, provide
unchallenging environment.
(b) Observe patient's behaviour at least
every 15minutes.
(c) Ensure that all sharp objects, glass or
mirror items, belts, ties, matchboxes
have been removed from patient's
environment.
(d) Redirect violent behaviour with
physical outlet.
(e) Encourage verbal expression of
feelings.
(f) Maintain and convey a calm attitude
to the patient. Talk to him in low, calm
voice, use clear and direct speech.
(g) Have sufficient staff to indicate a
show of strength to patient if
necessary.
(h) Administer tranquilizing medication; if
To minimize anxiety and suspiciousness.
Early intervention must be taken to
ensure patient's and others' safety.
These may be used to harm self or
others.
For relieving pent-up tension and
hostility.
-do
Anxiety is contagious and can be
transmitted from staff to patient.
This conveys control over the situation
and provides physical security for the
staff.
Explaining why the restriction is

14. Nursing interventions to improve nutritional status of manic
patient
Interventions Rationale
(a) Provide high-protein, high
caloric, nutritious finger foods
and drinks that can be
consumed 'on the run.'
(b)Find out patient's likes and
dislikes and provide favorite
foods.
(c)Provide 6 - 8 glasses of fluids
per day. Have juice and
snacks on unit at all times.
(d)Maintain accurate record of
intake, output and calorie
count. Weigh the patient
regularly.
(e)Supplement diet with vitamins
and minerals.
Patient has difficultly sitting still
long enough to eat a meal.
To encourage the patient to eat.
Intake of nutrients is required on
regular basis to compensate for
increased caloric requirements
due to hyperactivity.
These are useful data to assess
patient's nutritional status.
To improve nutritional status.
To offer support and to
encourage patient to eat.

15. Nursing interventions for manipulative behaviour
Interventions Rationale
(a) Recognize that manipulative
behavior helps to decrease feelings
of insecurity by increasing feelings
of power and control.
(b) Set limits on manipulative
behavior. Explain the
consequences if limits are violated.
Terms of the limits must be agreed
upon by all the staff who will be
working with the patient.
(c) Ignore attempts by patient to argue
or bargain his way out of the limit
setting.
(d) Give positive reinforcement for
non- manipulative behaviors.
(e) Discuss consequences of patient's
behavior and how attempts are
made to attribute them to others.
(f) Help patient identify positive
Understanding the rationale behind
the behavior may facilitate greater
acceptanceof the individual.
Consequences for violation of limits
must be consistently administered.
Lack of feedback may decrease these
behaviors.
To enhance self-esteem and promote
repetition of desirable behavior.
Patient must accept responsibility for
own behavior before adaptive change
can occur.
As self-esteem increases patient will
experience a lesser need to

16. Nursing interventions to improve self-esteem among manic
patient
Interventions Rationale
(a) Ask how client would like to be
addressed. Avoid approaches that
imply different perception of the
client's importance.
(b) Explain rationale for requests by
staff unit routine etc; strictly adhere
to courteous approaches, matter-
of-fact style and friendly attitudes.
(c) Encourage verbalization and
identification of feelings related to
issues of chronicity, lack of control
over self, etc.
(d) Offer matter-of-fact feedback
regarding unrealistic plans. Help
him to set realistic goals for himself.
(e) Encourage client to view life after
discharge and identity aspects over
which control is possible. Through
role play, practice how he will
Grandiosity is thought actually to
reflect low self-esteem.
Nursing approaches should reinforce
patient's dignity and worth;
understanding reasons enhances co-
operation with regimen.
Problem solving begins with agreeing
on the problem.
Unrealistic goals will increase failures
and lower self-esteem even more.
Role rehearsal is helpful in returning
patient to the level of independent
functioning. When the individual is
functioning well, sense of self-esteem
is enhanced

17. Nursing interventions to improve family coping
skills
Interventions Rationale
(a) Determine individual situation and
feelings of individual family members
like guilt, anger, powerlessness,
despair and alienation.
(b) Assess patterns of communication.
For example : Are feelings expressed
freely? who makes decisions? What
is the interaction between family
members?
(c) Determine patterns of behaviour
displayed by patient in his
relationships with others, e.g.
manipulation of self-esteem of others,
limit testing, etc.
(d) Assess the role of patient in the
family, like provider etc, and how the
illness affects the roles of other
members.
Living with family members having
bipolar illness fosters a multitude of
feelings and problems that can affect
interpersonal relationships and may
result in dysfunctional responses and
family disintegration.
Provides clues to the degree of problem
being experienced by individual family
members and coping skills used to
handle the crisis.
These behaviors are typically used by
the manic individual to manipulate
others. The result is alienation, guilt,
ambivalence and high rates of divorce.
When the role of an ill person is not filled
family disintegration can occur.
Assists family to understand the various
aspects of bipolar illness. This may