4. At the end of this presentation participants will
be able to:
Define Mania
Discuss Classification and Causes of Mania
Elaborate Symptoms and Treatment of Mania
Apply Nursing Process to the care of clients
with Mania
Provide education to Clients and families for
Mania
2nd August 2018 4made by Rashida GM (PGCN)
5. Mania is a term used to differentiate
bipolar disorder from depression.
Referring to mania as the “high”
component and depression as the “low”
component is common. However, mania
is much more than that.
2nd August 2018 5made by Rashida GM (PGCN)
6. 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).
2nd August 2018 6made by Rashida GM (PGCN)
7. Mania can be classified into three categories which
are:
1. MIXED STATUS: In a mixed state the individual
has co-occurring manic and depressive features
2. HYPOMANIA: In hypomania, there is less need for
sleep and both goal-motivated behavior and
metabolism increase.
3. ASSOCIATED DISORDER: A single manic
episode is sufficient to diagnose bipolar 1 disorder
2nd August 2018 7made by Rashida GM (PGCN)
8. A person may experience mania as a result of a
range of factors including:
Stressful events
Genetic factors
Biochemical factors ( neurotransmitter
abnormalities or imbalances)
Seasonal Influences
2nd August 2018 8made by Rashida GM (PGCN)
9. Heightened, grandiose, or agitated mood
Exaggerated self-esteem
Sleeplessness
Pressured speech
Flight of ideas
Reduced ability to filter out extraneous stimuli; easily
distractible
Increased number of activities with increased energy
Multiple, grandiose, high-risk activities, using poor
judgment, with severe consequences
2nd August 2018 9made by Rashida GM (PGCN)
10. The mechanism underlying mania is unknown, but the
neurocognitive profile of mania is highly consistent with
dysfunction in the right prefrontal cortex, a common finding in
neuroimaging studies.
Neurochemical influences of neurotransmitters (chemical
messengers) focus on serotonin and norepinephrine as the two
major biogenic amines implicated in mood disorders.
Deficits of serotonin found in the blood or cerebrospinal fluid
occur in people with mania
Norepinephrine levels may be increased in mania. This
catecholamine energizes the body to mobilize during stress and
inhibits kindling .
Dysregulation of acetylcholine and dopamine also is being
studied in relation to mood dysorders .
2nd August 2018 10made by Rashida GM (PGCN)
11. ONSET
The mean age for first manic episode is early 20s
Some people experience onset in adolescence, whereas others start
experiencing symptoms when they are older than 50
Manic episodes typically begin suddenly, with rapid escalation of
symptoms over a few days, and they last from a few weeks to
several months
CLINICAL COURSE
The diagnosis of mania require at least 1 week of unusual mood
changes in addition to three or more manic symptoms
Clients may stop taking medications because they like the
euphoria and feel burdened by the side effects , blood tests, and
physicians’ visits needed to maintain treatment
They do not understand how their illness affects others
2nd August 2018 11made by Rashida GM (PGCN)
12. Two kinds of
treatment modalities
are used to treat
mania i.e;
•Psychopharmacology
• Psychotherapy
2nd August 2018 12made by Rashida GM (PGCN)
13. Treatment for mania involves a lifetime regimen of
medications: either of the following;
Antimanic Agent (Lithium)
Anticonvulsant Drugs
Both are used as MOOD STABILIZERS
ANTIMANIC AGENT (LITHIUM)
Response rate in acute mania is 70%-80%
Onset of action is 5-14 days
Periodic serum lithium levels must be monitored
Maintenance levels 0.5-1mEq/L
Treatment levels 0.8-1.5mEq/L
Toxic levels 1.5mEq/L and above
2nd August 2018 13made by Rashida GM (PGCN)
14. ANTICONVULSANT DRUGS
Carbamazepine (Tegretol)
Therapeutic level 4-12 ug/mL
Valproic Acid (Depakote)
Therapeutic level 50-125ug/mL
Less frequently used are:
Gabapentin (Neurontin)
Lamoterigine (Lamictal)
Topiramate (Topamax)
Clonazepam (Klonopin)
IF MOOD STABILIZERS AND ANTICONVULSANTS FAIL
THEN ELECTRIC CONVULSIVE THERAPY MAY ALSO BE
GIVEN TO PREVENT CLIENT FROM SUICIDAL RISKS
2nd August 2018 14made by Rashida GM (PGCN)
15. Psychotherapy
combined with
medication can reduce
the risk for suicide and
injury
Provide support to the
client and family
Help the client to
accept the diagnosis and
treatment plan
2nd August 2018 15made by Rashida GM (PGCN)
16. 2nd August 2018 16
ASSESSMENT NURSING
DIAGNOSIS
EXPECTED
OUTCOMES
NURSING
INTERVENTION
S
RATIONALE
•Denial of
problems
•Grandiose
schemes, plans,
or stated self
image
•Buying sprees
•Sexual acting
out
Defensive coping
Repeated projection
of falsely positive
self-evaluation
based on a self-
protective pattern
that defend against
underlying
perceived threats to
positive self-regard
IMMEDIATE
The client will
Demonstrate
increased feelings
of self worth
STABILIZATION
The client will
Demonstrate
appropriate
appearance and
behavior
COMMUNITY
The client will
Use internal
controls to modify
own behavior
•Ignore or
withdraw your
attention from
bizarre appearance
and behavior and
sexual acting-out
•Give the client
positive feedback
whenever
appropriate
• initially structure
tasks at which the
client will succeed.
Gradually increase
the number and
complexity of
activities
•Withdrawing
attention can be
more effective than
negative
reinforcement in
decreasing
unacceptable
behavior
•It is essential to
support the client
in positive ways
•The client may be
limited in the
ability to deal with
complex tasks or
stimuli
made by Rashida GM (PGCN)
17. Provide for client’s physical safety and those
around
Set limits on client’s behavior when needed
Remind the client to respect distances between
self and others
Use short, simple sentences to communicate
Clarify the meaning of client’s communication
Frequently provide finger foods that are high in
calories and protein
Promote rest and sleep
2nd August 2018 17made by Rashida GM (PGCN)
18. Teach about bipolar illness and ways to manage the
disorder
Teach about medication management, including the need
for periodic blood work and management of side effects
For clients taking lithium, teach about the need for
adequate salt and fluid intake
Teach the client and family about signs of toxicity and the
need to seek medical attention immediately
Educate the client and family about risk-taking behavior
and how to avoid it
Teach about behavioral signs of relapse and how to seek
treatment in early stages
2nd August 2018 18made by Rashida GM (PGCN)
19. A mania is a distinct period during which
there is an abnormally and persistently
elevated, expansive, or irritable mood. Its
exact cause is not known but some
factors are considered responsible for it.
It is manifested by heightened,
grandiose, or agitated mood along with
sleeplessness. Treatment involves
psychopharmacology and psychotherapy.
2nd August 2018 19made by Rashida GM (PGCN)
20. Sheila L. Videbeck ; Psychiatric-Mental
Health Nursing; fifth edition, 2011.
https://www.slideshare.net
https://en.m.wikipedia.org/wiki/Mania
2nd August 2018 20made by Rashida GM (PGCN)
