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MANIA
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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
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HYPOMANIA Lesser degree of mania Mild elevation of mood
Increased sense of psychological well being and happiness , not keeping with ongoing events.
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PREDISPOSING FACTORS Biological theories Psychosocial theories
The transactional model
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BIOLOGICAL THEORIES Genetics Biochemical influences
Biogenic amines electrolytes Physiological influences Brain lesions Medication side effects
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PSYCHOSOCIAL THEORIES
Importance declined Mania is viewed as disease of brain with biological etiologies
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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
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CLINICAL FEATURES The underlined characteristics are:- Elevated mood
An increase in quantity & speed of physical & mental activity
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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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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
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BEHAVIORAL SYMPTOMS Aggressiveness Grandiose acts Hyperactivity
Increased motor activity Irresponsibility Irritability Argumentativeness
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BEHAVIORAL SYMPTOMS contd…
Poor personal grooming Provocativeness Increased social activity Dressed up in gaudy or flamboyant clothes Sexual hyperactivity
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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
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PHYSIOLOGICAL SYMPTOMS
Dehydration Inadequate nutrition (due to over-activity) Little need of sleep Weight loss
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CLASSIFICATION By ICD-10 F-30 = manic episode
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DIAGNOSIS ICD-10 Psychological tests as Young mania Rating Scale MSE
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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
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Mood & affect Euphoric, grandiosity, and false sense of well-being.
Mood is quite labile.
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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
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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
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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
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Self-concept Exaggerated self-esteem—believes they can accomplish anything A false sense of well being
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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.
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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
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TREATMENT Pharmacotherapy Electro-convulsive therapy
Psychological treatment
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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
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NURSING MANAGEMENT ASSESSMENT :- Severity of disorder.
Knowing the causes. Resources available. Judging the effect of patient’s behavior on other people. MSE
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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
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THANKS
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