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Mania - Coggle Diagram
Mania
- Application of the Mental Status Examination (MSE)
Appearance and Behaviour
The patient may wear bright-coloured, mismatched clothing.
The patient's appearance may be untidy.
Increased energy may lead to overactivity, pressure of speech, and a decreased need for sleep.
Increased activity may reduce food intake, or the patient may eat greedily.
Sexual desire may increase.
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Mood and Affect
The patient may appear cheerful and optimistic due to an elevated mood.
The patient may be irritable or suspicious without an elevated mood.
The patient may experience uncontrollable excitement.
The mood may change frequently.
Thoughts
Flight of ideas may occur.
Expansive ideas may occur.
The patient may make extravagant decisions, spending money or using resources without restraint.
The patient may make reckless decisions.
Grandiose delusions may occur.
Self-esteem may increase.
Delusions of persecution may occur.
Delusions of reference may occur.
Perceptions
Hallucinations may occur, especially auditory hallucinations and, rarely, visual hallucinations.
Cognitive Function
The patient may lose social inhibition, such as the ability to feel embarrassment.
The patient may be easily distracted and unable to sustain attention.
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- Nursing Management and Implementation
A. Implementation for Violent Behaviours
Environmental management
Provide minimum stimulation by reducing light, noise, and the number of people.
Observe frequently for signs of increasing anxiety or agitation.
Early warning signs
Increased motor activity.
Clenched teeth and fists.
Arguing.
Demanding.
Challenging.
Threatening.
Slamming.
Pounding.
Nursing interventions
Talk using a calm voice.
Encourage the patient to verbalise feelings.
Remove dangerous objects from the environment.
Redirect violent behaviours towards physical exercise.
Administer anxiolytics as prescribed.
B. Mechanical Restraints
Indication
Use mechanical restraints if the behaviour does not resolve with talking and medications and there is a danger to the patient or others.
Nursing care during restraint
Check the extremities every 15 minutes to assess circulation.
Loosen one restraint and reapply it before loosening another.
Provide passive range-of-motion exercises to restrained limbs.
Reposition the patient every two hours.
Assess skin integrity.
Use restraints only when necessary and avoid prolonged use.
C. Implementation for Risk of Injury
Provide a low-stimulation environment.
Remove dangerous objects.
Observe for agitation and hyperactive behaviours.
Provide scheduled activities with rest periods.
Limit group activities.
Administer medications, such as antipsychotics, as prescribed.
Maintain a distance of approximately an arm's length from the patient.
Maintain a clear exit route for staff and patients.
D. Implementation for Hyperactivity
Provide a low-stimulation environment.
Remove dangerous objects.
Observe for hyperactive behaviours.
Assist the patient in activities such as writing, drawing, and physical activities.
Stay with the patient.
Administer medications as prescribed.
E. Implementation for Imbalanced Nutrition
Provide nutritious foods, snacks, and drinks that can be consumed while moving around (finger foods).
Record intake and output and calorie intake.
Monitor weight.
Review laboratory reports.
Consider the patient's food preferences.
Provide supplementary vitamins and minerals.
Walk or sit with the patient until they finish eating.
- Medications
Mood stabilisersLithium.
Sodium valproate.
Carbamazepine.
Lamotrigine.Atypical antipsychoticsAripiprazole.
Olanzapine.
Risperidone.
Quetiapine.Typical antipsychoticsChlorpromazine.
Haloperidol.BenzodiazepinesBenzodiazepines are used for behavioural changes, lower activity, and sleep disturbances.
- ECT
Electroconvulsive therapy (ECT).
- Psychotherapy
Cognitive behavioural therapy (CBT).
Group therapy.
Interpersonal therapy.
Family, couple, and marital therapy.
- Psychosocial Approaches
These approaches help maintain well-being by addressing:
Adjustment to the disorder.
Marital and family issues, including separation.
Difficulties in interpersonal relationships, society, and occupational settings.
Financial loss or loss of employment.
Misuse of drugs.
- What is mania?
Mania is a state of abnormally and persistently elevated, expansive, or irritable mood, accompanied by high energy, hyperactivity, and a decreased need for sleep lasting at least one week (WHO).
- Epidemiology
Globally, 45 million people were affected (2021).The prevalence is approximately equal in males and females.
- Etiology
Genetic factors: Genetics is the main contributor.Environmental or social factors: Negative or stressful life events can trigger mania.
Examples include separated or divorced parents and child abuse.Neurochemistry: Dopamine activity, Norepinephrine, Serotonin.
- Course and Prognosis
The age of onset is 21 years.The condition usually begins with depression, and the first manic episode occurs five years later.The average length of a manic episode is six months.Most patients recover from the acute state and can lead a good social life within five years.Patients with psychotic symptoms may be unable to function in personal, family, social, educational, and occupational settings.The long-term prognosis is poor, although nearly all patients recover from acute episodes.
- Nursing Diagnoses for a Mania Episode
Risk for violence.
Risk for injury.
Imbalanced nutrition.
Ineffective coping mechanism.
Non-compliance.
Ineffective role performance.
Self-care deficit.
Chronic low self-esteem.
Disturbed sleep pattern.
- Relapse Prevention or Rehabilitation
Avoid medication non-compliance.
Maintain a mood diary.
Avoid triggers.
Provide education about early signs of relapse, such as sleep disturbances.
- Follow-up Assessment
Assess the severity of symptoms.
Review the mood diary.
Assess medication compliance.
Monitor side effects.
Assess the level of functioning.