psychiatric

1. AJAY
Psychiatric
c.
p

2. MANIA
case
presentation

3. Presenting
complaints
• A 23 yrs unmarried right handed Marathi speaking ,
Hindu religious male ganesh sankpal, educated B.E
,coming from chinchwad pune with the complaints of
• Irritability
• Wandering behaviour
• Muttering to self
• Suspiciousness
• Loudly speak
• Auditory hallucination
• Grandiosity
• Loss of memory
• Increased psychomotor activity
• Flight of ideas

4. HISTORY OF
ILLNESS
• According to informant pt is k/c/o/
psychiatric illness since 4 years was
remain untreated till now
• Patient wasshown psychiatric illness in past
then he was admitted in hospital 3 years
ago but absconded before treatment start
since then patient behaviour fluctuatively
(having unpredictable ups down )and now as
behaviour become unmanageble so he
brought to SGH

5. HISTORY OF
ILLNESS
• 4 yrs back his symptoms started within duration of
B.E F Y exam period and he was noticed anxious
during exam period & he was also noticed to be
talking to to self with gesturing of hand when
asked him ,then he
said its related to study
• He was noticed above symptoms with running on
road without any reason ,sudden stop going
temple and said ringing bell in my ears
• All this behaviour increased and told repeatedly
about his behaviour and parent brought to SGH
• No family history of psychiatric illness

6. DEFINATION OF
MANIA
• Mania refers to a syndrome in which
the central features are over activity,
mood change (which may be towards
elation OR irritability ) and self
important ideas

8. Classification of mania (ICD
10)
• F30
• F30.
0
• F30.
1
MANIC
EPISODE
HYPOMANIA
MANIA WITHOUT
PSYCHOTIC
SYMPTO
MS
• F30.
2
• F30.
8
• F30.
MANIA WITH PSYCHOTIC
SYMPTOMS OTHER MANIC
EPISODE
MANIC EPISODE UNSPECIFIED

10. ETIOLO
GY
Neurotransmitter and structural
hypothesis Excessive level of nor
epinephrine and dopamine
Imbalance between cholinergic and nor
adrenergic system and deficiency of
serotonin

11. Genetic
consideration
• 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

12. Psychodynamic
theory
• Developmental theorists have
hypothesized that faulty family
dynamics during during early life are
responsible for manic behaviors in
later life
Manic episode as a defense against or
denial of depression

24. Clinical features
In book
• Elevated ,Expansive
OR irritable mood
• 1)Euphoria
• 2)Elation
• 3)Exaltation
• 4) Ecstasy
In patient
• Elation and irritable
mood
• 1) irritability
• 2)wandering behaviour

25. In
boo
k
• Psychomotor
activity increased
• Speech and
thought
• Flight of ideas
• Pressure of speech
• Delusion of
grandiosity
• Delusion of
persecution
• Distractibility
cont
In
patient
• Psychomotor
activity increased
• Speech and
thought
• Flight of ideas
• Delusion of
grandiosity
• Big talk
• Speak loudly

26. con
t
In book
• Other features
• increasedsociability
• Impulsive behaviour
• Poor judgment
• Decreased sleep
• Absence of insight
• Decreased attention
and concentration
In patient
• Other features
• Poor judgment
• Decreased sleep
• Loss of memory
(amnesia)

40. Objective sings and
subjective symptoms of
manic patient
• Disturbance in speech
• Rapid speech
• Loud ,pressured
pressure
• Easily distracted
• Over activity
• Mood lability
• Weight change
Objective sings Subjective
symptoms • Feeling of joy
• Rapid mood swings
• Sleep disturbance
• Delusion and
hallucination