MHN

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MS.MAURYA SONAL
BSC NURSNG
MANIA

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INTRODUCTION
 Mania also termed as manic syndrome, is a state of abnormally
elevated mood, energy level, or increased emotional expression
together with liability of affect .
 Person experiencing a manic episode, remain euphoric, sleep
very little and may have hyperactivity.

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CLINICAL FEATURE OF MANIA
 Manic disorder is characterized by an elevated, irritable,
expansive and euphoric mood, increased psychomotor
activities, an inflated sense of self-esteem or grandiosity.
 People also demonstrate a decreased need for sleep, racing
thoughts, pressure of speech (racing thoughts) and increased
distractibility.

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AFFECTIVE SYMPTOMS
 Elevated mood: it has 4 stages depending on severity of manic
episodes.
 EUPHORIA (stage-I): increased sense of psychological well
being & happiness not in keeping with ongoing events.
 ELATION (stage-II) : moderate elevation of mood with increased
psychomotor activity.
 EXALTATION (stage-III): intense elation of mood with Delusions
of Grandeur.
 ECSTASY (stage-IV): severe elevation of mood intense sense of
rapture or blissfullness seen in delirious or stuporous mania

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COMMON SYMPTOMS OF MANIA
 Having an abnormally high level of activity or energy.
 Feeling extremely happy or excited - even euphoric.
 Not sleeping or only getting a few hours of sleep.
 Being more talkative than usual. Talking so much and so fast that
others can't interrupt.
 Having racing thoughts - having lots of thoughts on lots of topics
at the same time called “flight of ideas”.
 Being easily distracted.
 Being obsessed with and completely absorbed in an activity.
 Displaying purposeless movements.

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PSYCHOTIC SYMPTOMS OF A MANIC EPISODE
 Delusions - Delusions are false beliefs or ideas that are
incorrect interpretations of information. An example is a person
thinking that everyone they see is following them.
 Hallucinations - Having a hallucination means you see, hear,
taste, smell or feel things that aren't really there. An example is
a person hearing the voice of someone and talking to them
when they're not really there.

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DIAGNOSIS CRITERIA FOR MANIA
 Diagnostic Criteria for Manic Episode.
 Abnormally elevated, expansive or irritable mood for at least one week,
and at least three of the following symptoms that impair the personal,
social and occupational functioning of a person:
 Grandiosity or an inflated sense of self
 Little need for sleep
 Feeling pressured to speak, talking loudly and rapidly
 Easily distracted
 Significantly increased activities or motor agitation
 Engaging in risky behaviour like gambling or unprotected sex
 Racing thoughts
 The episode is not due to the physiological effects of a substance to
another medical condition.

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CLASSIFICATION OF MANIC EPISODE
 Manic episode can be classified based on the severity and
onset of the symptoms.
 Hypomania
 Mania without psychotic symptoms
 Mania with psychotic symptoms
 Mixed episodes

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HYPOMANIA
 It is a milder form of manic episode
characterized by the elevated or irritable mood,
increased energy level in case of mania and
will not interfere significantly in and
psychomotor activities, but not sufficient
severe as the personal, social and
occupational functioning of the affected person.

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MANIA WITHOUT PSYCHOTIC SYMPTOMS
 It is characterized by the elevated, expansive.
 or irritable mood, increased activity, increased talkativeness,
flight of ideas, loss of normal social inhibitions and decreased
need for sleep leading to severe interference in the personal,
social and occupational functioning of daily living.
 Subject will have any psychotic symptoms such not
hallucinations or delusions.

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MANIA WITH PSYCHOTIC SYMPTOMS
 It is characterized by same symptoms described above in the
presence of psychotic symptoms such as delusions (grandiose,
self-referential, erotic persecutory) or hallucinations.

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MANAGEMENT
 Pharmacological therapy.
 Combined therapy with lithium and sodium valproate may be
used in combination with antipsychotic agent.
 Lithium: The typical dose for mania is 900-2100 mg/day and
therapeutic blood dose of lithium is 0.6 to 1.2 mEq/L.
 Blood levels over 1.5 can be toxic and if > 3 mEq/L dialysis
required.- If condition of toxicity stops lithium dose.
 Behavior therapy - this may include life skills and how to
manage emotional reaction to stressors.

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NURSING MANAGEMENT
 ➤ 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 surroundings, safety etc.

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HIGH RISK FOR INJURY/ SELF HARM
 GOAL: Client will remain safe, & verbalize his suicidal ideation.
 Interventions:
 Establish calm and quiet non-stimulating environment.
 Keep all hazardous objects away from client's reach
 Keep strict vigilance on the activities of the client.
 Do not argue or provoke with the client.

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CONTI…
 Provide him diversional assistance in diverting the mind
 A Never leave the client alone.
 Avoid slippery floor to avoid accidents.
 ➤ Encourage him to express strongly held feeling and emotions.
 ➤ Administer medicines as prescribed.

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HIGH RISK FOR VIOLENCE
 En vironmental of care : - Client will remain safe, & verbalize his
suicidal ideation.
 Interventions:
 ➤ Assess suicidal thinking, including frequency, plan,
opportunity, post attempts.
 ➤ Provide close observation.

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FAMILY DYNAMICS THEORY
 1. Psychodynamic theory =Psychoanalytical theory focuses on
an early unsatisfactory parent/child relationship, with an
unresolved grieving process.
 2. Biological theory=A family history of major affective disorders
may exist in individuals with depressive disorders.
 Biochemical factors implicate the biogenic amines nor-
epinephrine, dopamine, and serotonin.
 The levels of these chemicals are deficient in individuals with
depressive disorders.
 3. Family Dynamics theory= Object loss theory suggests that
depressive illness.

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ALTERED THOUGHT PROCESS
 EOC: - Client will recover from perceptual and thought
disturbances.
 Interventions:
 Be with the client, reorient him to the present situation.
 Reduce external stimuli in client's environment.
 Engage him in some pleasurable activities.

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