Sub: Psychiatric and mental health nursing

For 3rd year B.Sc in  nursing students and Diploma in Nursing


Mania:Mania is a functional psychosis. The disease is characterized by three triad of symptoms like elevation of mode, flight of ideas and increase psycho-motor is associated with bipolar disorder.

Classification:   there are three type of mania.  They are – a. Hypo mania, b. mania without psychotic syndrome, c. mania with psychotic syndrome, d. manic episode unspecified.

  1. Hypo mania: this is a lesser degree of mania. There is a mild elevation of mode, increase activity and energy.
  2. Mania without psychotic syndrome: It is a moderate degree of mania and disturbs the normal activity. Mode is irritable and suspicious.
  3. Mania with psychotic syndrome: it is the more severe form of mania delusion and self- neglect will be present.
  4. Manic episode unspecified.

Etiology or causes:

  1. Biological causes:
  2. Genetics: Increase chances in first degree relatives. Biochemical: increase the level nor epinephrine and dopa mine
  3. Psychological causes: early childhood experience: Maternal deprivation, prolong absence of parent. b. sociological: life events, e.g. death, financial loss. c. Behavioral: Defense against depression.

Clinical feature of Mania:

  1. Elevated mode for distinctive period of time – feeling happy, optimistic, euphoric, and irritable.
  2. Changing in thinking: thinking completely illogical, Flight of ideas, unable to distinguish between real and not real, delusion of grandeur, paranoid delusion, Hallucination, impaired judgment due poor decision making skills.
  3. Changes in behavior:  increase activity or socialization, immersion in plans or project, speech uncontrollable, excessive spending, over committed to quitting job. Impulsive sexual involvement, some may hostile.
  4. Change in physical condition: Less need for sleep, increase energy, fewer health complaints.

Management of mania:

  • Medical management:
  • Anti-psychotic drugs– Chlorpromazine-300mg -600mg daily in divided dose. Heloperidol-0.5 mg -30 mg in divided dose, it usually controls excitement.
  • Procyclidine: 5-10 mg use to minimize side effect.
  • Mode stabilizer medications are the hallmark treatment for mania.
  • Lithium carbonateg. carbamazepine (tegretol) and valproic Acid ( Depakote,Depakene) for stabilizing the mood.
  • ECT is recommended for treatment of acute severe mania when the patient fails to response to lithium or other drug treatment.

Nursing management:

  1. Reinforce the patient self-control and positive aspect of the behavior.
  2. Be sure to take medication regularly as prescribe.
  3. Reduce stress as much as possible.
  4. Assist the patient to ventilate anger in an appropriate way.
  5. Stay in non-stimulus surroundings. Avoid dances and bars.
  6. Encourage the patient to work independently whenever possible.
  7. Help the patients to increase positive thinking.
  8. Learn and practice relaxation technique.
  9. Avoid over stimulation.
  10. Encourage the patients in family and group therapy.
  11. Try to keep your thoughts focused, not rambling or observe.
  12. Assist the patient to meet his self-care, Nutrition, sleep and personal hygiene.