Mania. bipolar disorder. manic disorder
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The document is a comprehensive overview of mania, including its definition, symptoms, etiology, classification, diagnostic evaluations, treatment modalities, and nursing assessments. It details the different stages of mania—hypomania, acute mania, and delirious mania—along with their corresponding symptoms and behaviors. Additionally, pharmacological and psychosocial treatment options are outlined, followed by nursing diagnoses and interventions aimed at patient care.
Mania. bipolar disorder. manic disorder
- 1. MANIA Ms Mamta Bisht MSc nursing 1st year Psychiatric nursing SCON 1
- 2. Introduction 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). 2
- 3. Meaning of Mania The word is derived from the Greek word (mania) meaning "madness, frenzy" 3
- 4. Definition 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
- 5. ETIOLOGY 1. Biological theories genetics first degree relatives Monozygotic twins Biochemical influences Excess of nor-epinephrine and dopamine Low serotonin Physiological Right sided lesions in limbic system, temporobasal areas, basal ganglia, and thalamus. Enlarged ventricles and subcortical white matter 5
- 6. 2. Psychosocial theories Both biological and psychosocial factors(such as environmental stressors) may cause mania. 3. The transactional model Bipolar disorders mostly results from genetic, biological and psychosocial determinants. The cycle may be directly linked to external stressors. The transactional models considers these stressors as well as past experiences, existing condition and individual’s perception of the event. 6
- 7. Classification According to the symptoms Mania can be classify into 3; these are. 1. Hypomania 2. Acute mania 3. Delirious mania 7
- 8. HYPOMANIA At this stage the disturbance is not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization Mood: cheerful and expensive Unfulfilled desires will bring irritability Nature is volatile and fluctuating 8
- 9. Cognition and Perception: Ideas of great worth and ability Flight of ideas Easily distracted Goal directed activities are difficult Activity and behaviour: Increases motor activity Extroverted and sociable Talk and laugh too much, usually very loudly and often inappropriately Increased libido Anorexia and weight loss in some cases 9
- 10. 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 10
- 11. Cognition and Perception: Fragmented and often psychotic cognition and perception Flight of ideas Accelerated pressured speech which abruptly changes from topic to topic Speech is disorganized and coherent Hallucinations and delusions(usually paranoid and grandiose) Attention can be diverted even by small stimuli 11
- 12. Activity and behavior: Excessive psychomotor activity Incresed sexual interest Poor impulse control manipulate others to crry out their wishes, and if things go wrong very skillfully project responsibility for the failure onto others Need for sleep is diminished Extremely energetic 12
- 13. May go for many days without sleep and still don’t feel tired Neglected hygiene and grooming Dress may be disorgnized, flamboynt or bizarre Excessive makeup or jwellery 13
- 14. 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, quickly converting to unrestrained merriment and ecstasy Irritable or indifferent to the environment Panic anxiety may be evident 14
- 15. Cognition and perception: Clouding of consciousness Confusion, disorientation and sometimes stupor Religiosity delusions of grandeur or persecution Auditory or visual hallucinations Extremely distractible and incoherent 15
- 16. Activity and Behaviour: Psychomotor activity is frenzied and characterized by agitated, purposeless movements Safety of these individuals is at stake unless this activity is curtailed Exhaustion, injury to self or others and eventually death could occur without intervention 16
- 17. DIGNOSTIC EVALUTIONS 1. Psychological tests such as young mania rating scale 2. ICD 10 diagnostic criteria 17
- 18. Signs and symptoms 1. Elevated expansive or irritable mood Stages of elevated mood Euphoria(stage l) : increased sense of psychological well being and hàppiness Elation(stage ll) : moderte elevation of mood with increased psychomotor activity Exalation(stagelll) : intense elevtion of mood with delusion of Grandeur Ecstasy(stage lV) : severe elevation of mood. Intense sense of blissfulness 18
- 19. 2. Psychomotor activities: Incresed psychomotor activity ranging from over activeness to manic excitement 3. Speech and Thought: Flight of ideas Pressure of speech Delusion of Grandeur Delusion of Persecution Distractibilty 19
- 20. Other Features: Increased sociability Poor judgement High risk activities Decresed need for sleep(<3hrs) Decresed food intake Decresed attention Poor judgement Absent insight 20
- 21. Treatment modalities There are basically 3 types treatment modalities; Phrmcological treatment Psycho - social Treatments ECT 21
- 22. PHARMACOLOGICAL TREATMENT Mood stabilizers(anti-manic drugs) lithium (900-2100mg/day)-drug of choice carbamazepine (200-1600mg/day) Sodium valproate (600-2600mg/day) Anticonvulsants: Clonazepam(0.5-20mg/day) Calcium channel blockers: Verapamil(80-320mg) Antipsychotics Olanzapine(10-20mg) Chlorpromazine(75-400mg) 22
- 23. Psycho-Social Treatment 1. Family Therapy 2. Cognitive Therapy 3. Individual Psychotherapy 4. Group Therapy 23
- 24. Electro-Convulsive Therapy ECT can also be used for acute manic excitement , if not adequately responding to antipsychotics and Lithium 24
- 26. NURSING DIGNOSIS 1. Risk for injury related to extreme hyperactivity and impulsive behaviour, as evidenced by lack of control over purposeless and potentially injurious movements 2. Impaired social interaction related to short attention span, high level of distractibility and labile mood , as evidenced by insufficient or excessive quantity or ineffective quality of social exchange 3. Ineffective coping skills related to poor impulse control evidenced by acting out behaviour 26
- 27. 4. Disturbed thought process related to disorientation and decreased concentration as evidenced by disruption in activities 5. Altered family process related to euphoric mood and grandiose ideas, manipulative behaviour as evidenced by changes in family relationships. 27
- 28. Nursing intervention Develop a relationship with the person based on empathy and trust. Ensure that the person remains free from injury. Assist the person to decrease their agitation and hyperactivity. Promote positive health behaviors, including medication compliance and healthy lifestyle 28
- 29. CON’T Promote the person’s engagement with their social and support network. Ensure effective collaboration with other relevant service providers, through development of effective working relationships and communication. Support and promote self-care activities for families and carers of the person with mania. 29
- 30. REFERENCES Textbooks: 1. Townsend. Mary. C; “Psychiatric Mental Health Nursing” ; Jaypee Brothers Medical Publishers (P) ltd ; 8th edition ; pp. 499-522R 2. Shreevani . R ; “textbook of Mental Health and Psychiatric Nursing ; 3rd edition ; Jaypee Publications ; pp. 3. Malik Santosh ; “Textbook of Psychiatric Nursing” ; Lotus Publishers ; 1st Edition ; 2010 ; pp. 173-179 30
- 31. Assignment Write down a nursing care plan for a manic patient. 31
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