mania , pritesh ,ppt

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

2. Introduction :-
• A Mania is a distinct period during
which there is an abnormally and
persistently elevated, expansive, or
irritable mood. This period of abnormal
mood must last at least 1 week (or less
if hospitalization is required).

3. Definition :-
• 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“.

4. ClassifiCation
• Mania can be classify into 3; these are
• Mixed states; In a mixed state the individual has co-occurring manic
and depressive features.
• Hypomania; In hypomania, there is less need for sleep and both
goal-motivated behavior and metabolism increase.
• Associated disorders; A single manic episode is sufficient to diagnose
bipolar I disorder

5. Etiology
Neurotransmitter and structural hypothesis:-
• Excessive level of nor epinephrine and dopamine
• Imbalance between cholinergic and noradrenergic system and deficiency of
serotonin.
• Biological findings suggest that lesions are more common in this population in
areas of the brain such as right hemisphere or bilateral subcortical and
periventricular gray matter.
Genetic considerations:-
• Monozygotic (identical) twines have a higher rate of incident than normal
siblings and other close relatives.
• Common among the family members of bipolar patient
• First degree relatives 5-10 % chance
• Identical twins with bipolar disorders about 40-70% chance

6. Con…
• 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).

7. 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 ongoing events.
• ELATION (Stage-II): Moderate elevation of mood with increased psychomotor
activity
• EXALTATION (Stage-III): Intense elevation of mood with delusion of grandeur.
• ECSTASY(Stage-IV): severe elevation of mood, intense sense of rapture or
blissfulness. Expansive mood is unceasing and unselective enthusiasm for
interacting with people and surrounding environment. Sometimes irritable mood
may be predominant, especially when the person is stopped from doing what he
wants.
• 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 .

8. 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

9. Con …
• Other features:
• Increased sociabilities
• Impulsive behavior
• Disinhibition
• Hypersexual and promiscuous behavior
• Poor judgement
• 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(< 3 hour)
• Decreased food intake due to over-activity
• Decreased attention and concentration
• Absent insight

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

11. 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.

12. 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.

13. NURSING MANAGEMENT:-
• Nursing assessment :-
• Obtain general history of the client including social ,educational ,
oocupational ,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 .

14. 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.

15. 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 ram between
you and weapon
• Distract the patient momentarily to remove the weapon.
• Give prescribed antipsychotic medications.

16. 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

17. 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.

18. Thank you