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

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

29. THANKS