CASE PRESENTATION
ON
MANIA
SUBMITTED TO: MRS ANJU MAM
SUBMITTED BY: PRIYA
DEFINITION
•A MANIA IS A MOOD DISORDER
INWHICH THERE IS AN ABNORMALLY
AND PERSISTENTLY ELEVATED,
EXPANSIVE, OR IRRITABLE MOOD.
CLASSIFICATION
• MANIA CAN BE CLASSIFY INTO 3; THESE ARE
• MIXED STATES; 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 BEHAVIOR
AND METABOLISM INCREASE.
• ASSOCIATED DISORDERS; A SINGLE MANIC EPISODE
IS SUFFICIENT TO DIAGNOSE BIPOLAR I DISORDER
ETIOLOGY
• NEUROTRANSMITTER AND STRUCTURAL HYPOTHESES:
•
• MANIC EPISODES ARE RELATED TO EXCESSIVE LEVELS OF
NOREPINEPHRINE AND DOPAMINE, AN IMBALANCE BETWEEN
CHOLINERGIC AND NORADRENERGIC SYSTEMS OR A
DEFICIENCY SEROTONIN.
• GENETIC CONSIDERATIONS:
• MONOZYGOTIC (IDENTICAL) TWINS HAVE A
HIGHER RATE OF INCIDENCE THAN NORMAL
SIBLINGS AND OTHER CLOSE RELATIVES.
• PSYCHODYNAMIC THEORIES:
• DEVELOPMENTAL THEORISTS HAVE HYPOTHESIZED
THAT FAULTY FAMILY DYNAMICS DURING EARLY
LIFE ARE RESPONSIBLE FOR MANIC BEHAVIORS IN
LATER LIFE.
CLINICAL FEATURES
• ELEVATED, EXPANSIVE OR IRRITABLE MOOD
• ELEVATED MOOD IN MANIA HAS FOUR STAGES DEPENDING
ON THE SEVERITY OF MANIC EPISODES.
• 1: EUPHORIA
• 2:ELATION
• 3:EXALTATION
• 4:ECSTASY
FOUR STAGES OF ELEVATED MOOD
• EUPHORIA (STAGE 1): INCREASED SENSE OF PSYCHOLOGICAL WELL-BEING
AND HAPPINESS NOT IN KEEPING WITH ONGOING EVENTS
• ELATION (STAGE II): MODERATE ELEVATION OF MOOD WITH INCREASED
PSYCHOMOTOR ACTIVITY
• EXALTATION (STAGE III): INTENSE ELEVATION OF MOOD WITH DELUSIONS OF
GRANDEUR
• ECSTASY (STAGE IV). SEVERE ELEVATION OF MOOD, INTENSE SENSE OF
RAPTURE OR BLISSFUINESS SEEN IN DELIRIOUS OR STUPOROUS MANIA
CLINICAL FEATURE
• INCREASED PSYCHOMOTOR ACTIVITY
• FLIGHTS OF IDEAS
• CLANG ASSOCIATION
• DELUSIONS
• IMPULSIVE BEHAVIOR
• HYPERSEXUALITY
• DECREASED NEED OF SLEEP
• DECREASED FOOD INTAKE
• POOR JUDGEMENT
DIAGNOSIS
• PSYCHOLOGICAL TESTS SUCH AS YOUNG
MANIARATING SCALE
• ICD10 DIAGNOSTIC CRITERIA
• BASED ON SIGNS AND SYMPTOMS.
TREATMENT
• PHARMACOTHERAPY
•
• LITHIUM: 900-2100 MG/DAY
• CARBAMAZEPINE: 600-1800 MG/DAY
• SODIUM VALPROATE: 600-2600 MG/DAY LAMOTRIGINE: 25-200
MG/DAY
• OTHER DRUGS: CLONAZEPAM, CALCIUM CHANNEL BLOCKERS, ETC.
PSYCHOSOCIAL TREATMENT
• 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 TREATMENT AND ADEQUATE
DRUG COMPLIANCE.
NURSING DIAGNOSIS 1
• HIGH RISK INJURY RELATED TO IMPULSIVE BEHAVIOR
• KEEP ENVIRONMENTAL STIMULI TO A MINIMUM.
• REMOVE HAZARDOUS OBJECTS AND SUBSTANCE.
• STAY WITH PATIENT AS HYPERACTIVITY INCREASES.
• ADMINISTER MEDICATION AS PRESCRIBED BY THE PHYSICIAN.
NURSING DIAGNOSIS 2
IMBALANCED NUTRITION RELATED TO LESS INTAKE OF FOOD.
PROVIDE HIGH CALORIE, HIGH PROTEIN AND NUTRIOUS DIET.
PROVIDE 6-8 GLASSES OF FLUIDS PER DAY.
MAINTAIN ACCURATE RECORD OF INTAKE OUTPUT AND
CALORIE COUNT.
