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 activity.it 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.
- Hypo mania: this is a lesser degree of mania. There is a mild elevation of mode, increase activity and energy.
- Mania without psychotic syndrome: It is a moderate degree of mania and disturbs the normal activity. Mode is irritable and suspicious.
- Mania with psychotic syndrome: it is the more severe form of mania delusion and self- neglect will be present.
- Manic episode unspecified.
Etiology or causes:
- Biological causes:
- Genetics: Increase chances in first degree relatives. Biochemical: increase the level nor epinephrine and dopa mine
- 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:
- Elevated mode for distinctive period of time – feeling happy, optimistic, euphoric, and irritable.
- 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.
- 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.
- 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.
- Reinforce the patient self-control and positive aspect of the behavior.
- Be sure to take medication regularly as prescribe.
- Reduce stress as much as possible.
- Assist the patient to ventilate anger in an appropriate way.
- Stay in non-stimulus surroundings. Avoid dances and bars.
- Encourage the patient to work independently whenever possible.
- Help the patients to increase positive thinking.
- Learn and practice relaxation technique.
- Avoid over stimulation.
- Encourage the patients in family and group therapy.
- Try to keep your thoughts focused, not rambling or observe.
- Assist the patient to meet his self-care, Nutrition, sleep and personal hygiene.