Mania 2024 PDF

Mania Prepared by: Dr. Entisar Mohammed Assistant professor of Psychiatric Mental Health Nursing Department  Objectives: At the end of this lecture the student will be able to : 1. Identify meaning of mania 2. List types of mania 3. Analyze the biological and psychological theories...

Mania Prepared by: Dr. Entisar Mohammed Assistant professor of Psychiatric Mental Health Nursing Department  Objectives: At the end of this lecture the student will be able to : 1. Identify meaning of mania 2. List types of mania 3. Analyze the biological and psychological theories that as basis for caring for patients with mood disorders 4. Develop observation skills to determine psychiatric symptoms in the care of manic patient 5. Understanding different types of treatment modalities 6. Apply nursing process in caring for manic patients Out lines * Introduction * Definition Of mania * Types Of mania * Etiology * Clinical Manifestations of mania * Treatment * Conclusion * References  Introduction The word is derives from the Greek (mania) meaning "madness, frenzy“ A Mania is a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood. This period of abnormal mood must last at least 1 week (or less if hospitalization is required). Definition Mania is the mood of an abnormally elevated arousal energy level. Mania is a state of extreme physical and emotional elation. Types of Bipolar Disorder Bipolar I More timein depressed state Long periods of normality Bipolar II Long episodes of depression, occasional hypomania Virtually no time of wellness Types of Bipolar Disorder Cyclothymia persistent at least 2 years Many episodes of hypomania Occasional mild depression Mixed states Signs of depression and mania at same time Rapid cycling Many cycles of mania and depression each year Four or more episodes a year  Difference between mania and hypomania Mania Hypomania ▪ Symptoms are sufficiently severed to ▪ Symptoms are not severe enough to cause marked impairment in cause marked impairment in social or occupational functioning or in usual occupational functioning. activities or relationship with others. ▪ Hospitalization is needed to protect ▪ Hospitalization is not indicated. patient and others. ▪ There are psychotic symptoms. ▪ Absence of any psychotic symptoms.  Etiology : The exert mechanism by which mania occurs is not yet known.  Neurotrnsmitters and structural hypothesis  Norepinephrine  Dopamine  Serotonin  Genetic consideration  First Degree relatives: 5-10%  Identical twins:40-70%  Psychodynamic theory  Faulty family dynamic during early life  Defense against or Denial of depression  Mental status examination : Clinical features General appearance & behavior:- Psychomotor agitation ; sitting still is difficult may wear clothes that reflect elevated mood ( brightly colored clothes, flamboyant, attention-getting, ) Pressured speech and Interrupts and cannot listen to others Thought process and content Flight of ideas Cannot connect concepts and jump from one subject to another Circumstantiality and Tangentiality Do not consider risks or personal experience, abilities or resources. Some experience psychotic features– grandiose delusions Sensorium and intellectual processes Oriented to person and place but rarely to time Intellectual function is difficult to assess during the manic phase Impaired ability to concentrate or pay attention If psychotic—may experience hallucination Judgment and insight Easily angered and irritated Impulsive and rarely think before acting or speaking Insight is limited---believes they are “fine” and have no problems Blames any difficulties on others Exaggerated self-esteem—believes they can accomplish anything A false sense of well being Roles and Relationships Rarely can fulfill role & responsibilities. Have trouble at work or school---too distracted and hyperactive to pay attention to children. Begins many tasks or projects but completes few. Physiologic and self-care considerations Can go days sleep or food and not even realize they are hungry or tired Unwilling to stop or unable to rest or sleep Ignores personal hygiene destroy valued items May physically injure themselves Tend to ignore or be unaware of health needs  Treatment modalities There are basically 3 types treatment modalities; 1. Psychological Treatments 2. Physical Treatments ( E C T) 3. Organic Treatments Organic Treatments; this involve the used of drugs Mood stabilizers: lithium (0.6—1.2 mEq/L) carbamazepine (6—12 mg/L) ,valproate (50—125 mg/L)  Anticonvulsants: Depakene, gabapentine ,topiramate , lamotrigine antipsychotics of second generation (Clozapine, olanzapine, risperidone) Benzodiazepines (lorazepam, clonazepam) Indication of anti manic A- Psychiatric uses:- 1. Treatment of symptoms of acute mania 2. Treatment of depressive episode. 3. Schizoaffective disorder. 4. Reduce impulsivity and aggression in certain psychiatric patients. B- Non - psychiatric uses ❖ Bulimia nervosa Contraindications Precautions - Elderly patients - Diabetes mellitus - Patient with thyroid disorders - Urinary retention. - History of seizure disorder. Lithium is contraindicated in patients with:- - Hypersensitivity to the drug. - Severe cardiovascular or renal diseases. - Severe dehydration. - Sodium depletion. - Brain damage. - Pregnancy and lactation.  Side Effects Nursing Interventions Drowsiness–Dizziness– * Ensure that patient does not participate in activities Headache that require alertness such as car driving. Polyuria ▪ Inform patient that increased urination is common ▪ Urine output is large in and benign. volume. ▪ Monitor intake and output. ▪ Patient may complain of ▪ monitor for skin turgor daily. urinating that it interferes ▪ Report changes (e.g., altered ratio of intake and with daily living activities output – sudden weight gain or loss) to physician. including sleep. Polydipsia (Increased ▪ Provide patient with sugarless candy, ice or frequent sips thirst ) of water. ▪ Strict oral hygiene is very important. ▪ Avoid exposure to sun. Gastrointestinal upset ▪ Recommended that patient take lithium during or after (nausea, vomiting or meals or with a glass of milk abdominal discomfort) Fine hand tremors ▪ Provide support and reassurance. ▪ Tremor worsens with anxiety and intentional movements; minimize stressors ▪ Reduction or elimination caffeine containing beverages, who may decrease dose of medication. Weight gain ▪ Instruct patient regarding reduced calorie diet. ▪ increasing exercise ▪ Emphasize importance of maintaining adequate intake of sodium. Hypothyroidism ▪ Inform patient that this is reversible and treatable. ▪ Thyroid hormone replacement as ordered. ▪ Nurse should observe for dry skin, constipation, hair loss, cold intolerance, bradycardia and other signs of hypothyroidism. Edema of feet or ▪ Monitor of intake and output, check for possible decreased hands urinary output. ▪ Monitor sodium intake. ▪ Patients should elevate legs when sitting or lying. ▪ Monitor weight  Lithium Blood Levels and Associated Side Effects Plasma level Side Effects or Symptom of Toxicity < 1.5 mEq/L ▪ Metallic taste in mouth ▪ Fine hand tremors ▪ Mild and transient Nausea ▪ acne ▪ Polyuria, Polydipsia ▪ Diarrhea or loose stools ▪ Muscular weakness or fatigue ▪ Weigh gain ▪ Edema ▪ Dry mouth 1.5– 2 mEq/L Severe diarrhea, vomiting, nausea Incoordination Dizziness Muscle irritability 2-3 mEq/L Slurred speech ataxia Coarse tremor Visual or tactile hallucination Blurred vision Incontinence Oliguria , renal failure Confusion