mania ..

1. Mania
PRESENTED BY :-
PATEL PRITESH D
M.Sc.Nursing in Mental Health

2. Introduction :-
• Mania is the mood of an abnormally elevated arousal
energy level.
• Mania is a state of extreme physical and emotional
elation.
• The word is derives from the Greek (mania) meaning
"madness, frenzy”.

3. Definition :-
• MOOD DISORDERS:-
• Mood disorders are characterized by a disturbance
of mood , accompanied by a full or partial manic
or depressive syndrome , which is not due to any
other physical or mental disorder .
• Mania is an alteration in mood that is
characterized by extreme happiness, extreme
irritability, hyperactivity, little need for sleep and
/or racing thoughts which my lead to rapid, speech.

4. Etiology :-
• 1 Biological theories :-
• Genetics :-
• Genetic factors are very important in predisposing an
individual to mood disorders. The lifetime risk for the first-
degree relatives of patients with bipolar mood disorderis
25% and of normal controls is 7%.The lifetimerisk for the
children of one parent with mood disorder is 27%and of
both parents with mooddisorder is 74% . The concordance
rate for monozygotic twins is 65% ...

5. Con ..
• Biochemical Influences
( neurotransmitter abnormalities or imbalances )
• Biochemical theories A deficiency of norepinephrine and
serotonin has been found in depressed patients and they
are elevated in mania.

6. Con …
• 2 . Psychosocial theories :-
• Both biological and psychosocial factors (such
environmental stressors ) may cause mania .

7. Con…
3 . A person may experience mania as a result of a range of factors,
including :- ….
• Stressful events
• Genetic factors
• Biochemical factors (neurotransmitter abnormalities or
imbalances)
• Seasonal influences
• Bipolar affective disorder (BPAD).

8. Con ..
• 4 . OTHERS:-
• Brain injury
• Brain tumor
• Dementia
• High levels of stress
• Medication side effcet
• Sleep deprivation
• Stroke
• Trauma or abuse

9. Classification :-
Classification According to the symptoms Mania can be
classify into 3, these are.
• 1. Hypomania
• 2. Acute mania
• 3. Delirious mania

10. Con …
• HYPOMANIA :-
• At this stage the disturbance is not sufficiently severe to cause
marked impairment in social or occupational functioning and
no require hospitalization .
• Mood : -
• cheerful and expensive .
• Unfulfilled desires will bring irritability .
• Nature is volatile .

11. Con …
• Cognition and Perception :-
• Ideas of great worth and ability .
• Flight of ideas .
• Easily distracted .
• Goal directed activities are difficult .
• Activity and behavior : -
• Increases motor activity ..
• Talk and laugh too much, usually very loudly and often inappropriately .
• Increased libido .
• Anorexia and weight loss in some cases .

12. Con …
• ACUTE MANIA :-
• Most individual experience marked impairment in functioning and
require hospitalization
Mood:-
Euphoria and elation
Mood is variant easily changing to irritability and anger or even sadness
and crying

13. Con ….,
• Cognition and Perception:-
• Flight of ideas
• Accelerated pressured speech which abruptly changes from
topic to topic
• Speech is disorganized
• Hallucinations and delusions(usually paranoid and grandiose)
• Attention can be diverted even by small stimuli

14. Con......
• Activity and behavior : -
• Excessive psychomotor activity
• Incresed sexual interest
• Poor impulse control manipulate others to cary out their
wishes, and if things go wrong very skillfully project
responsibility for the failure into others .
• Extremely energetic

15. Con ….
• May go for many days without sleep and still don’t feel tired .
• Neglected hygiene and grooming .
• Dress may be disorgnized, .
• Excessive makeup or jwellery .

16. Con …
• DELIRIOUS MANIA :-
• Severe form of mania with clouding of consciousness and intensification
of the symptoms associated with acute mania
• Mood: -
• Labile
• May show Feelings of despair.
• Irritable or indifferent to the environment
• Panic anxiety may be evident

17. Con …
• Cognition and perception:
• Clouding of consciousness
• Confusion, disorientation and sometimes stupor
• Religiosity
• delusions of grandeur or persecution
• Auditory or visual hallucinations

18. Con ….
• Activity and Behavior : -
• Psychomotor activity is frenzied and characterized by
agitated, purposeless movements
• Safety of these individuals is at stake unless this activity is
reduce .
• injury to self or others and eventually death could occur
without intervention

19. Signs and symptoms
• Elevated, expansive or irritable Mood:-Elevated mood in mania has
four stages depending on the severity of manic episodes;
• EUPHORIA (Stage-I):Increased sense of psychological well-being
and happiness not in keeping with on going events.
• ELATION (Stage-II): Moderate elevation of mood with increased
psychomotor activity
• EXALTATION (Stage-III): Intense elevation of mood with delusion
of grandeur.

20. Con ..
• ECSTASY(Stage-IV): severe elevation of mood, intense sense of rapture
or blissfulness.
• Psychomotor activity:-
There is an increased psychomotor activity ranging from over
activeness and restlessness to manic excitement. These activities are
goal-oriented and based on external environment .

21. Con ..
• Speech and thought:-
• Flight of ideas: Thoughts are racing in mind, rapid shifts from one to
another .
• Pressure of speech: Speech is forceful, strong and difficult to interrupt.
Uses playful language with punning, rhyming, joking, teasing and speaks
loudly.
• Clang association: These are ideas that are related only by similar or
rhyming sounds rather than actual meaning.
• Delusions of grandeur
• Delusions of perception
• Distractibility

22. Con …
• Other features:
• Increased sociabilities.
• Impulsive behavior.
• Hypersexual and promiscuous behavior
• Poor judgement.
• High-risk activities .

23. Con :-
• Dressed up in gaudy and flamboyant clothes although in severe
mania there may be poor self-care
• Decreased need for sleep(< 3 hour)
• Decreased food intake due to over-activity
• Decreased attention and concentration
• Absent insight

24. DIAGNOSIS:-
• Psychological tests such as young mania Rating Scale
• ICD 10 diagnostic criteria
• Based on sign and symptoms

25. TREATMENT MODALITIES:-
• PHARMACOTHERAPY:
• Lithium: 900-2100 mg/day
• Carbamazepine: 600-1800 mg/day
• Sodium valproate: 600-2600 mg/day
• Lamotrigine: 25-200 mg/day
• Other drugs: clonazepam, calcium, calcium channel blockers, etc.
• Electroconvulsive Therapy(ECT)
ECT can also can be used for acute manic excitement if not adequately
responding to antipsychotic and lithium.

26. Con …
• Psychosocial Treatment
• Family and marital therapy is used to decrease intrafamilial and
interpersonal difficulties and to reduce or modify stressors. The main
purpose is to ensure continuity of treatment and adequate drug
compliance.
• Family therapy
• Cognitive therapy
• Group therapy
• Individual psychotherapy

27. NURSING MANAGEMENT:-
• Nursing assessment :-
• Obtain general history of the client including social
,educational , occupational ,economic status ,family , past and
present history etc .
• Perform mental status examination to assess the mental
functioning of the client .
• Perform physical examination to assess any physical illness.
• Observe for environmental sarroundings ,safety etc .

28. Con …
• NURSING DIAGNOSIS :-
• High risk for injury related extreme hyperactivity and impulsive behavior
as evidenced by lack of control over purposeless and potentially injurious
movements …..,
• Interventions:
• Keep environmental stimuli to a minimum; keep lighting and noise level low.
• Remove hazardous objects and substances, caution the patient when there is
possibility of an accident.
• Assist patient to engage in activities, such as writing, drawing and other
physical exercise.
• Stay with patient as hyperactivity increases.
• Administer medication as prescribed by physician.

29. Con …
• High risk for violence; self-directed or directed at others related to manic
excitement, delusional thinking and hallucinations.
• Interventions:
• Never see a potentially violent person alone .
• Keep a comfortable distance away from the patient .
• Be prepared to move, violent patient can strike out suddenly .
• Maintain a clear exit route for both the staff and patient .
• Be sure that the patient has no weapons in his possession before approaching
him .
• Keep something like pillow, mattress or blanket wrapped around .
• Distract the patient momentarily to remove the weapon .
• Give prescribed antipsychotic medications .

30. Con …
• Altered nutrition, less than body requirements related to inability to sit still long
enough to eat, as evidenced by weight loss .
• Interventions:-
• Provide high protein diet, high caloric, nutritious finger food and drinks that can be
consumed on the run
• Find out patient’s like dislike and provide favorite food
• Provide 6-8 glasses of fluid per day. Have juice and snacks on unit at all times
• Maintain accurate record of intake, output and calorie count. Weigh patient regularly
• Supplement diet with vitamins and minerals
• Walk and sit with patient while he eats

31. Con….
• Impaired social interaction related to egocentric and narcissistic behavior as
evidenced by inability to make satisfying relationships
• Interventions:-
• Recognize that manipulate behavior helps to decrease feelings of insecurity
by increasing feelings of power and control
• Set limits on manipulate behavior. Explain the consequences if limits are
violated.
• Ignore attempts by patients to argue or bargain his way-out of the limit
setting.
• Give positive reinforcement for non-manipulative behaviors.

32. Thank you
pritesh d patel , mhn . ppt