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MANIA - Coggle Diagram
MANIA
MEDICATION
Anxiolytics, benzodiazepines. By binding to specific receptor sites, benzodiazepines appear to potentiate the effects of gamma-aminobutyric acid (GABA) and facilitate inhibitory GABA neurotransmission and the action of other inhibitory neurotransmitters.
Mood stabilizers. Lithium is the drug commonly used for prophylaxis and treatment of manic episodes.
Anticonvulsants. Anticonvulsants have been effective in preventing mood swings associated with bipolar disorder, especially in those patients known as rapid cyclers.
Antipsychotics, 2nd generation. Second generation, or atypical, antipsychotics are increasingly being used for treatment of both acute mania and mood stabilization in patients with bipolar I disease.
Antipsychotics, 1st generation. First-generation antipsychotics, also known as conventional or typical antipsychotics, are efficacious in treating both psychotic and nonpsychotic manic and mixed episodes, as well as hypomania.
Antipsychotics, phenothiazine. Phenothiazine antipsychotics, which are classified as first-generation antipsychotics, are efficacious in treating both psychotic and nonpsychotic manic and mixed episodes, as well as hypomania.
Antiparkinsons agents, dopamine agonists. Dopamine agonists are non-errgot agents that bind to D2 and D3 dopamine receptors in the striatum and substantia nigra.
PATHOPHYSIOLOGY
The pathophysiology of mania and bipolar disorder, in general, has been shown in some studies to involve specific brain regions; however, the exact mechanisms involved are still unknown.
In functional studies as well as structural studies, bipolar disorder patients have shown alterations in the amygdala, hippocampus, basal ganglia, prefrontal cortex and the anterior cingulate.
The amygdala is hyperactive in patients with Bipolar Disorder, and the hippocampus and prefrontal cortex are hypoactive. This increased activity in the amygdala along with decreased activity in cortical regions may be the reason why the executive function is impaired in mania while the emotions are heightened and unrestrained.
NURSING INTERVENTIONS
Providing for safety. A primary nursing responsibility is to provide a safe environment for client and others; for clients who feel out of control, the nurse must establish external controls emphatically and nonjudgementally.
Meeting physiologic needs. Decreasing environmental stimulation may assist client to relax; the nurse must provide a quiet environment without noise, television, and other distractions; finger foods or things client can eat while moving around are the best options to improve nutrition.
Providing therapeutic communication. Clients with mania have short attention spans, so the nurse uses simple, clear sentences when communicating; they may not be able to handle a lot of information at once, so the nurse breaks information into many small segments.
Promoting appropriate behavior. The nurse can direct their need for movement into socially acceptable, large motor activities such as arranging chairs for a community meeting or walking.
Managing medications. Periodic serum lithium levels are used to monitor the client’s safety and to ensure that the dose given has increased the serum lithium level to a treatment level or reduced it to a maintenance level.
BEHAVIORAL INTERVENTIONS
Tell the person what is expected of him other, but realistic. For Example, if the person needs to pace, facilitate this in an area that does not disrupt others. Encourage respect for the personal space of others, and also show respect for the person experiencing mania.
Encourage and support any ideas the person has that are realistic and in keeping with his or her healthcare regime.
Encourage the person to organise and slow his or her thoughts speech patterns, by focusing on one topic at a time and asking questions that require brief answers only.
If his or her thoughts and speech became confused, try to cease the conversation and sit quietly together to help him or her calm down.
Provide the person with consistent limits. Make sure all staff are clear about these and that they reinforce set limits. Give the person clear, simple directions. It is far more effective to suggest alternative strategies, because the person will be easily distracted, rather than directly forbid an action.
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PATIENT EDUCATION
Reinforce reality by talking about actual events and topics such as unit activities. Engaging the patient into reality and present issues can increase a here-and-now focus.
Encourage frequent high-calorie protein drinks and finger foods, examples, sandwiches, fruit, milkshakes. Constant fluid and calorie replacement are needed. The patient might be too active to sit at meals. Finger foods allow for “eating on the run.
Encourage frequent rest periods during the day. Lack of sleep can lead to exhaustion and exacerbate manic symptoms.
Give simple step-by-step reminders for hygiene and dress, example, “Here is your razor. Shave the left side … now the right side.” “Here is your toothbrush. Put the toothpaste on the brush. Distractibility and poor concentration are countered by simple, concrete instructions.