IMPORTANT

1. MANIA

2. Definition
An abnormally elevated mood state
characterized by such symptoms as
• Inappropriate elation,
• Increased irritability
• Severe insomnia,
• Grandiose notions,
• Increased speed or volume of speech
• Disconnected & racing thoughts
• Increased sexual activity level
• Poor judgment and appropriate social
behavior

3. HYPOMANIA
• Lesser degree of mania
• Mild elevation of mood
• Increased sense of
psychological well being and
happiness , not keeping with
ongoing events.

4. PREDISPOSING FACTORS
• Biological theories
• Psychosocial theories
• The transactional model

5. BIOLOGICAL THEORIES
• Genetics
• Biochemical influences
Biogenic amines
electrolytes
• Physiological influences
Brain lesions
Medication side effects

6. PSYCHOSOCIAL
THEORIES
• Importance declined
• Mania is viewed as disease of brain
with biological etiologies

7. TRANSACTIONAL MODEL
PRECIPITATING FACTORS
FAMILY HISTORY OF MANIA
PAST EPISODE OF MANIA
POSSIBLE ELECROLYTE IMBALANCE
POSSIBLE CEREBRAL LESIONS
POSSIBLE MEDICATION SIDE EFFECTS
COGNITIVE APPRAISAL
PRIMARY-THREAT TO LOSS OF SELF ESTEEM
SECONDARY-INABILITY TO USE COPING MECHANISMS
QUALITY OF RESPONSE
ADAPTIVE MALADAPTIVE
UNCOMPLICATED DENIAL OF DEPRESSION
BEREAVEMENT SYMPTOMS OF MANIA

8. CLINICAL FEATURES
The underlined characteristics are:-
• Elevated mood
• An increase in quantity & speed of
physical & mental activity

9. 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

10. AFFECTIVE SYMPTOMS
• Elevated mood
• Expensiveness
• Humorousness
• Inflated self esteem
• Intolerance of criticism
• Lack of shame or guilt
• Sometimes irritable mood is predominant
• May shift from Euphoria to Depression
or Anger

11. BEHAVIORAL SYMPTOMS
• Aggressiveness
• Grandiose acts
• Hyperactivity
• Increased motor activity
• Irresponsibility
• Irritability
• Argumentativeness

12. BEHAVIORAL SYMPTOMS
contd…
• Poor personal grooming
• Provocativeness
• Increased social activity
• Dressed up in gaudy or
flamboyant clothes
• Sexual hyperactivity

13. COGNITIVE SYMPTOMS
• Ambitiousness
• Denial of realistic danger
• Easily distracted
• Flight of ideas
• Uses playful language
• Speaks loudly
• Delusions of grandeur
• Delusion of persecution
• Lack of judgment
• Distractibility

14. PHYSIOLOGICAL
SYMPTOMS
• Dehydration
• Inadequate nutrition (due to
over-activity)
• Little need of sleep
• Weight loss

15. CLASSIFICATION
• By ICD-10
• F-30 = manic episode

16. DIAGNOSIS
• ICD-10
• Psychological tests as Young mania
Rating Scale
• MSE

17. MENTAL STATUS
EXAMINATION
• GENERAL APPEARANCE &
BEHAVIOR:-
• Psychomotor agitation ; sitting
still is difficult
• may wear clothes that reflect
elevated mood---brightly colored
clothes, flamboyant, attention-
getting, Pressured speech
• Interrupts and cannot listen to
others

18. Mood & affect
• Euphoric, grandiosity, and false
sense of well-being.
• Mood is quite labile.

19. Thought process and content
• flight of ideas
• Cannot connect concepts and jump
from one subject to another
• Circumstantiality and Tangentiality
• Do not consider risks or personal
experience, abilities or resources.
• Some experience psychotic features–
grandiose delusions

20. Sensorium and intellectual
processes
• Oriented to person and place but
rarely to time
• Intellectual function is difficult to
assess during the manic phase
• Claims to have many abilities that they
do not possess
• Impaired ability to concentrate or pay
attention
• If psychotic—may experience
hallucination

21. Judgment and insight
• Easily angered and irritated
• Impulsive and rarely think before
acting or speaking
• Insight is limited---believes they
are “fine” and have no problems
• Blames any difficulties on others

22. Self-concept
• Exaggerated self-esteem—believes
they can accomplish anything
• A false sense of well being

23. Roles and Relationships
• Rarely can fulfill role &
responsibilities.
• Have trouble at work or school---
too distracted and hyperactive to
pay attention to children or ADLs.
• Begins many tasks or projects but
completes few.

24. Physiologic and self-care
considerations
• Can go days w/o sleep or food and not
even realize they are hungry or tired
• Unwilling to stop or unable to rest or
sleep
• Ignores personal hygiene
• destroy valued items
• May physically injure themselves
• Tend to ignore or be unaware of
health needs

25. TREATMENT
• Pharmacotherapy
• Electro-convulsive therapy
• Psychological treatment

26. • MOOD STABILIZERS
• Antimanic - Lithium
• Anticonvulsant - clonazepam,
valproic acid
• Calcium channel blocker - verapamil
• ANTIPSYCHOTICS
• Olanzapine, Risperidone, Quetiapine
Chlorpromazine, Haloperidol
• SEDTIVES/HYPNOTICS
• benzodiazepines
PSYCHOPHARMACOLOGY

27. NURSING MANAGEMENT
• ASSESSMENT :-
• Severity of disorder.
• Knowing the causes.
• Resources available.
• Judging the effect of
patient’s behavior on other people.
• MSE

28. Nursing Diagnosis
• Risk for injury related to extreme
hyperactivity
• Risk for violence r/t manic
excitement
• Imbalanced nutrition less than body
requirement related to refusal
• Impaired social interaction r/t
egocentric behaviour