MANIA

 Christabel Kabindama aged 23 yeras is brought to the psychiatric hospital amidst talking and shouting on top of her voice non-stop. She is accompanied by Mwaka Ng'ambi who said she is also unable to sleep and claims she owns Livingstone College of Nursing and have supper powers. After examinations a diagnosis of mania is made.

DEFINE MANIA

Mania is a mental condition with distinct period during which mood is abnormally and persistently elevated, expansive, or irritable.

STATE THE PREDISPOSING FACTORS TO MANIA

There is no specific known cause for mania. However, the predisposing factors are biopsychosocial in nature and includes the following:

Biological factors

Genetics. Mania is hereditary in nature. First degree relatives with these disorders are more likely to develop the mood disorder than people in the general population.

Biochemistry.

Research have shown that those with mania have too much of serotonin and epinephrine.

Social factors

Stressful life events, lack of social support, and environmental stress and poverty can predispose a person to mood disorders.

Physiological factors

Right sided lesion on the temporal part of the brain, the limbic area or the thalamus can lead to secondary mania.

Medication side effects

Certain drugs used to treat somatic illnesses can lead to manic episode e.g chronic use of steroid therapy.

CLINICAL MANIFESTATION

Flight of ideas- continuous rapid shift from one point to another.

Loquaciousness ( pressure of speech)

Persecutory delusions

Grandiose delusions: patient feels he/she is all powerful and most important.

Continuous euphoria elated affect/mood or excessive happiness

Excessive motor activity

Loss of appetite

Disturbed sleep patterns

Inability to concentrate: are easily destructed by slightest stimuli

Hallucinations.

MANAGEMENT

Treatment

MOOD STABILIZERS:

Lithium 200 - 300mg Tds orally.

Side Effects; ringing in the ear, blurred vision, muscle weakness and hand tremors.

ANTIPSYCHOTICS

Risperidone 2.5 - 6mg OD orally until symptoms resolve. Ziprazidone 40 - 80mg BD orally

Side Effects; postural hypotension, sedation and cholinergic effect(dry mouth, diarrhoea, vomiting)

ANTICONVULSANTS

Valproate - start loading dose 25mg for 4 weeks, then 50 - 100mg

Carbamazepine - start loading dose 25mg for 4 weeks, then 50 - 100mg

Side effects; sedation, cholinergic effects (dry mouth, diarrhoea, nausea and vomiting)

NURSING MANAGEMENT

Aims/Goals

Restore the normal mood or behavior and enable patient suit in community.

Prevent injury to patient and others

To prevent malnutrition and/ or restore nutritional status in a patient.

Restore normal thought processes in a patient.

1. Safe environment

2. Nurse-patient relationship

3. Therapeutic communication

4. Hygiene

5. Nutrition

6. Social interaction/Group therapy

7. Behavior therapy

8. Psychosocial therapy

9. Information Education and Communication

NURSING CARE PLAN

Risk of injury to self and to others related to extreme hyperactivity, destructive behavior, anger directed at the environment and increased agitation evidenced by hitting head, hand or foot against the wall.

Impaired social interaction related to altered thought process evidenced by verbal manipulation.

Altered nutrition less than body requirement related to, refusal or inability to sit still long enough to eat and lack of appetite evidenced by loss of weight.

Sleep pattern disturbance related to excessive hyperactivity, agitation and biochemical alteration evidenced by pacing up and down during sleep time and sleeping only short periods at a time.

Disturbed thought processes related to biochemical alterations or psychotic process evidenced by inappropriate thoughts like delusions.

Disturbed sensory perception related to sleep deprivation evidenced by inappropriate responses like answering to an abnormally perceived call.