MANIA - NURSING

1. MOOD
DISORDERS

2. MOOD DISORDERS :
Mood/affective Disorders
are characterised by a
disturbance of mood,
accompanied by a full or
partial manic or depressive
syndrome, which is not due
to any other physical and
mental disorder.

3. CLASSIFICATION
• F 30 : MANIC EPISODE
• F 31: BIPOLAR AFFECTIVE DISORDER
• F32 : DEPRESSIVE EPISODE
• F33 : RECURRENT DEPRESSIVE
DISORDER
• F34: PERSISTENT MOOD DISORDER
• F38 : OTHER MOOD DISORDERS
• F39 : UNSPECIFIED MOOD DISORDERS

4. DEFINITION
Manic behaviour is characterised
by “an abnormally and
persistently elevated, expansive
or irritable mood”
- APA

5. • Mania refers to a syndrome in which
the central features are over activity,
mood change and self important ideas.

6. ICD-10 CLASSIFICATION
• F30-39- mood ( affective disorder)
F30- manic episode
F30.0- Hypomania
F30.1- mania without psychotic
symptoms
F30.2- mania with psychotic symptoms
F30.8-other manic episode
F30.9- manic episode unspecified

7. PREDISPOSING FACTORS
• Biological Theories
Genetics :
Twin study
Family study
Biochemical influences: biogenic
amines (n.e,sero, dop.)
Physiological influences: brain lesions
and medication side effects
Electrolytes:
• Psychosocial Theories
• The Transactional Model

8. ETIOLOGY
• Neurotransmitter and structural
hypothesis
• Genetic consideration
• Psychodynamic theories : faulty
family dynamics or denial of
depression

9. CLASSIFICATION OF MANIA
ACCORDING TO APA 2000
1. Hypomania
2. Acute mania
3. Delirious Mania
4. Delusional mania
5. Secondary mania
6. Chronic mania

10. HYPOMANIA
• Mood : cheerful and expansive
• Cognition and perception : Perceptions of the
self are exalted, ideas of great worth and
ability, easily disturbed , flight of ideas
• Activity and behaviour: increased motor
activity, extroverted and sociable, talk and
laugh a lot , increased libido , sometime show
in appropriate behaviours

11. ACUTE MANIA
• Symptoms of acute mania may be a
progression in intensification of those
experienced in hypo mania
• euphoria and elation
• the mood is always subject to frequent
variation , easily changing to irritability and
anger
• Rapid thinking , flight of ideas, pressured
speech
• Paranoid and grandiose delusions
• illusion and hallucination are common.
• motor activity is excessive, sexual interest is
increased, excessively spend money, Hygiene
and grooming may be neglected

12. DELIRIOUS MANIA
• It is a grave form of the disorder
characterised by severe clouding of
consciousness and representing an
intensification of the symptoms
associated with acute mania.
• The mood of this person is labile
• clouding of consciousness, confusion,
disorientation and sometimes stupor.
• religiosity, delusions of grandeur or
persecution, auditory or visual
hallucination

13. • agitated purposeless movements
• injury to others or self, and eventually
death could occur

14. DELUSIONAL MANIA
• is characterised by less excitement,
more persistent grandiose delusions
and even occasional hallucinations.

15. SECONDARY MANIA
• is due to drugs, thyrotoxicosis, acute
and chronic organic mental syndrome,
tumors, epilepsy, multiple sclerosis,
encephalitis etc.

16. CHRONIC MANIA
• lose their euphoria, become irritable
and resentful and acquire a paranoid
like attitude.

17. STAGES OF ELEVATED MOOD
• EUPHORIA: increased sense of
psychological wellbeing and happiness
not in keeping with ongoing events
• ELATION: moderate elevation of mood
with increased psychomotor activity
• EXALTATION: Intense elevation of
mood with delusion of grandeur.
• ECSTASY: severe elevation of mood,
intense sense of rapture or blissfulness

18. PSYCHOPATHOLOGY OF MANIA
• Manic states shows lack of inhibition,
apparent quickness of psychological reaction,
distractibility and flight of ideas.
• Elation of mood is accompanied by a feeling
of general well- being, which in the manic
state is manifested as lack of insight.

19. CLINICAL FEATURES
Elevated mood : 4
stages
Expansive mood:
unceasing and
unselective
Irritable mood
Psychomotor activity
Speech and thought
Attention

20. SPEECH AND THOUGHT
• Pressure of speech
• Flight of ideas
• Delusion of grandeur
• Delusion of persecution
• Distractibility

21. OTHER FEATURES
• Increased sociability
• Impulsive behavior
• Disinhibition
• Hypersexual and promiscuous behavior
• Poor judgment
• High risk activities
• Decreased need for sleep
• Absent insight

22. DIAGNOSIS
• ICD 10 diagnostic criteria
• Young mania rating scale( RC Young
1978)
• Based on signs and symptoms

24. TREATMENT
• Pharmacotherapy
• Electroconvulsive
therapy
• Psychosocial treatment

25. PHARMACOTHERAPY
• Lithium – 900-1200 mg/ day
• Carbamazepine- 600-1800 mg/day
• Sodium valproate- 600-2600 mg/day

26. NURSING MANAGEMENT

27. ASSESSMENT

28. NURSING DIAGNOSIS
• High risk for injury related extreme
hyperactivity and impulsive behavior as
evidenced by lack of control over
purposeless and potentially injurious
movements
• High risk for violence; self directed or
directed at others related to manic
excitement , delusional thinking and
hallucinations.

29. • Altered nutrition, less than body requirements
related to inability to sit still long enough to
eat, as evidenced by weight loss.
• Impaired social interaction related to
egocentric and narcissistic behavior as
evidenced by inability to make satisfying
relationships
• Self esteem disturbance related to unmet
dependency needs and lack of positive
feedback
• Altered family processes related to euphoric
mood and grandiose ideas.

30. THANK YOU