MANIA Definition An abnormally elevated mood state characterized

MANIA

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

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

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

BIOLOGICAL THEORIES • Genetics • Biochemical influences ü Biogenic amines ü electrolytes • Physiological influences ü Brain lesions ü Medication side effects

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

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 UNCOMPLICATED BEREAVEMENT MALADAPTIVE DENIAL OF DEPRESSION SYMPTOMS OF MANIA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

TREATMENT • Pharmacotherapy • Electro-convulsive therapy • Psychological treatment

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

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

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

T N A H S K