A LESSON PLAN ON

Mania

SUBMITTED TO: SUBMITTED BY:

Mrs. Sonali Waghmare, Mr. Dipak S. Sawarkar
Asso. Professor. 1st yr. MSc Nursing
Kasturba Nursing College, Sewagram. Kasturba Nursing College, Sewagram.
Name of the teacher : Mr. Dipak Suresh Sawarkar

Subject : Mental Health Nursing

Unit :

Topic : Mania

Class : 1st yr. MSc Nursing

No. of students : 40

Date & time :

Duration of class : 45 Minutes

Venue : 3rd year basic BSc Nursing

Methods of teaching : Lecture and discussion

A.V aids : Power point presentation, black board, chart, Flash card.

Name of teacher evaluator : Mrs. Sonali Waghmare

General objective : At the end of the class students will be able to acquire in-depth

knowledge regarding alternative therapies in psychiatry.

GENERAL OBJECTIVE:-

At the end of the seminar the group will be able to gain the knowledge regarding the Mania and its

implication in psychiatric nursing practice.

SPECIFIC OBJECTIVE:-

At the end of the seminar the group will be able to:-

 Define Mania.
 Explain Classification of Mania.
 .
 Describe about relaxation therapy and clinical application of the relaxation therapy, limitation of relaxation
therapy.
 To describe about meditation and breathing clinical application of meditation and limitation of meditation.
 To explain about yoga.
 To describe about imagery, clinical application of imagery and limitation of imagery.
 To explain about prayer.
 To describe about music therapy.
 To explain about humor and laughter.
 To describe about hypnosis.
 To explain about aromatherapy.
 To explain about training-specific therapy.
 To describe about biofeedback.
 To describe about therapeutic touch.
 To describe about chiropractic therapy.
 To explain about traditional Chinese medicine.
 To tell about acupuncture.
 To describe about herbal therapy.
 To explain about nurse role in complementary and alternative therapy.

TEACHING
SR TIME SPECIFIC CONTENT AV AIDS LEARNING EVALUATI
NO OBJECTIVE ACTIVITY ON

1
2 min Introduces the INTRODUCTION LCD Lecture cum Introduction
topic. discussion. of maia?
Mania is a psychological condition that causes a
person to experience unreasonable euphoria, very
intense moods, hyperactivity, and delusions. Mania
(or manic episodes) is a common symptom of bipolar
disorder. Mania can be a dangerous condition for
several reasons. People may not sleep or eat while in
a manic episode.

2 min Defines Mania.

DEFINITION: LCD Lecture cum Define
Manic refers to a syndrome in which central discussion. Mania?

features are over-activity, mood change (which may

be towards elation or irritability) and self-important
ideas.
A mania is a distinct period during which there is
an abnormally and persistently elevated, expansive,
3 min Classification of
 Mania. or irritable mood.
Black Lecture cum Classify
board discussion. mania ?
CLASSIFICATION OF MANIA

F30 Manic episode

F30.0 Hypomania
F30.1 Mania without psychotic symptoms
F30.2 Mania with psychotic symptoms
F30.8 Other manic episodes
F30.9 Manic episode unspecified

Mania can be classify into 3 types : These are

 Mixed state : In a mixed state the individual
has co-occurring manic and depressive
features.
 Hypomania : In hypomania, there is less need
for sleep and both goal motivated behaviour
7 min Etiology for
mania. and metabolism increase. LCD Lecture cum Explain the
discussion etiology of
 mania?
 Associated disorders : A single manic episode
is sufficient to diagnose bipolar I disorder.

ETIOLOGY :
1. Neurotransmitter and Structural
Hypotheses

 Excessive level of norepinephrine and

dopamine
 Imbalance between cholinergic and
noradrenergic systems or a deficiency in
serotonin.
 Biologic findings suggest that lesions are more
common in this population in areas of the
brain such as the right hemisphere or bilateral

2. Genetic Considerations
 Monozygotic (identical) twins have a higher
rate of incidence than normal siblings and
other close relatives.
 Siblings and close relatives have a higher
incidence of manic-depressive illness than a
general population, and cyclothymic
characteristics are common among family
members of bipolar patients.
 First degree relative: 5-10% chance
 Identical twin with bipolar disorders:
About 40-70% chances

3. Psychodynamic Theories

 Developmental theorists have hypothesis that

faulty family dynamics during early life are
responsible for manic behaviors in later life.

 Another psychodynamic hypothesis explains

 manic episodes as a defense against or denial
of depression.

4. Seasonal Influences
Pathophysiologi LCD
5 min  Manic episode peak during spring/summer and Lecture cum Explain the
cal mechanism
of mania to a lesser extent. discussion. pathophysiol
ogical
mechanism
5. Stressful event of mania?
 Death of loved one
 Financial stress
 Stressful relationship
 Illness condition like hypothyroidism

PATHOPHYSIOLOGICAL MECHANISM
 The mechanism underlying mania is unknown,
but the neurocognitive profile of mania is
 highly consistent with dysfunction in the right
per-frontal cortex, a common findings in
neuroimaging studies.
 Neurochemical influences of neurotransmitter
5 min (chemical messengers) focus on serotonin and LCD
Enlist the Lecture cum
norepinephrine as the two major biogenic Which are
clinical features discussion.
of Mania. amines implicated in mood disorder. the clinical
features of
 Deficits of serotonin found in the blood in the mania?
blood or cerebrospinal fluid occur in people
with mania.
 Norepinephrine levels may increased in mania.
This catecholamine energizes the body to
mobilize during stress and inhibits kindling.

 Dysregulation of acetylcholine and dopamine

also is being studied in relation to mood
disorders.
CLINICAL FEATURES OF MANIA

1. Elevated, Expansive or Irritable Mood

Elevated mood in mania has four stages depending
on the severity of manic episodes
 Euphoria (Stage I): Increased sense of
psychological well-being and happiness not in
keeping with ongoing events
 Elation (Stage Il): Moderate elevation of.
mood with increased psychomotor activity
 Exaltation (Stage Ill): Intense elevation of
mood with delusions of grandeur

 Ecstasy (Stage IV): Severe elevation of mood,

intense sense of rapture or blissfulness seen in
delirious or stuporous mania.
2. Increase psychomotor Activity
 3. Speech and Thought
 Flight of ideas
 Pressure of speech
 Clang association
 Delusions of grandeur
 Delusions of persecution
 Distractibility

Other Features
 Increased sociabilities
 Impulsive behavior
 Disinhibition
 Hypersexual and promiscuous behavior
3 min LCD
Enlist the  Poor judgment Lecture cum
diagnosis discussion.
evaluation for Which are
mania  High-risk activities (buying sprees, reckless the
diagnostic
driving, foolish business investments, evaluation
distributing money or articles to unknown for mania?
persons)
  Dressed up in gaudy and flamboyant clothes
although in severe n mania there may be poor
self-care
 Decreased need for sleep (<3 hours)
 Decreased food intake due to over-activity LCD
Lecture cum
5 min  Decreased attention and concentration Poor discussion
Treatment judgment Explain the
modalities for treatment
 Absent insight
Mania for mania?
Symptoms of hypomania

 Persistent mild elevation of mood

 Irritability
 Conceit

 Boorish behavior
 Impaired concentration and attention
 Inability to settle down to work
 Diagnosis of Mania
 Psychological test such as young Mania Rating
Scale
 ICD 10 diagnostic criteria
 Based on sign and symptoms
 The physician or psychiatrist can evaluate a
patient for mania by asking questions and
discussing symptoms
 Direct observation

Treatment modalities
Pharmacotherapy LCD Lecture cum
3 min discussion.
Mood stabilizers:
Nursing Discuss the
management for  Lithium: 900-2100 mg/day nursing
mania management
  Carbamazepine: 600-1800 mg/day for mania?
 Sodium valproate: 600-2600 mg/day

Anticonvulsants:

 Gabapentin: 100-300 mg/day

 Topiramate: 25-50 mg/day
 Lamotrigine: 25-200 mg/day

Other drugs: Clonazepam, calcium channel

blockers, etc.

LCD

5 min Electroconvulsive Therapy (ECT)

Nursing  ECT can also be used for acute manic
diagnosis for
mania excitement if not adequately responding to
antipsychotics and lithium.
LCD,
Psychosocial Treatment black boa
 Family and marital therapy is used to decrease
 intrafamilial and interpersonal difficulties and
to reduce or modify stressors. The main
purpose is to ensure continuity of treatments
and adequate drug compliance.

Nursing management for Mania

 Develop the relationship with person based on
empathy and trust
 Ensure that the person remains free from
injury
 Assist the person to decrease their agitation
and hyperactivity
 Provide positive health behaviors, including
medication compliance and healthy lifestyle
 Provide for client’s physical safety and those
 around
 Set limits on client’s behavior when needed
 Remind the client to respect distances between
self and others
 Use short, simple sentence to communicate
 Clarify the meaning of client’s communication
 Frequently provide finger foods that are high
calorie and protein
 Promote rest and sleep.

Nursing diagnosis for Mania

Nursing diagnosis I
High-risk for injury related to extreme hyperactivity
and impulsive behavior, evidenced by lack of control
over purposeless and potentially injurious
movements.
Nursing diagnosis II
High-risk of violence; self-directed or directed at
others related to manic excitement, delusional
thinking and hallucinations.
Nursing diagnosis III
Altered nutrition, less than body requirements related
to refusal or inability to sit still long enough to eat,
evidenced by weight loss, amenorrhea.

Nursing diagnosis IV
Impaired social interaction related to egocentric and
narcissistic behavior, evidenced by inability to
develop satisfying relationships manipulation of
others for own desire
Nursing diagnosis V
Self-esteem disturbance related to unmet dependency
needs, lack of positive feedback, unrealistic self-
expectations
Nursing diagnosis VI
Altered family processes related to euphoric mood
and grandiose ideas, manipulative behavior, refusal
to accept responsibility for own actions.

Text books
1. Townsend c Mary, text book on
“Psychiatric Mental Health Nursing.” Jaypee
publications. 5 edition, page 322-335
th

2. Sreeveni R, text book on “A guide to

Mental Health and Psychiatric Nursing”
Jaypee publications, 4 edition, page 117-121
th

3. Perry potter, fundamentals of nursing, mosby

an imprint of Elsevier, sixth edition, page
no 910-913.
4. Kozier Barbaram Erb Leora et al.
Fundamentals of Nursing Concept &
Practice. 7th edition 2004. Pearson
 Education Inc. pg. No. 223 to 235.

5. Brenda G Bare, Suzanna C. Smeltzer. Text

Book Medical Surgical Nursing. 19th
edition 2004. Lippincot Williams and
Wilkins, Philadelphia. Pg. No. 100 to 100.
6. Newton Linda. Complementary and
Alternative Therapies the Nurse’s Role.
Journal of Neuroscience Nursing, August
2006, pg. No. 1.