mania
DESCRIPTION
brief description on maniaTRANSCRIPT
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MANIA
Dr Madhura.T.K.
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Definition:
Distinct period during which there is abnormally persisting elevated, expansive or irritable mood.
Mood disorders – syndrome, with cluster of signs & symptoms
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Common underlying characteristics• Elevated mood• Increase in quantity & speed of physical &
mental activity
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Clinical features
MOOD:
Elevated, feels on the top of the world
Feeling of intense well being
Irritability, outbursts of unprovoked anger
:
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IMPAIRMENTS IN (N) FUNCTIONING: Excess energy, tiredness & exhaustion Over activity: ^ level of motor activity actions – hurried & clumpsy Conduct & behavior: lot of attention colorful clothes, lack of social inhibition-
abrasive, over familiar & outspoken, reckless spending of money
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Cont…..
Bodily sym. ^ appetite
decreased need for sleep
^sexual need
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IMPACT ON PSYCHOLOGICAL FUNCTIONS:
Thinking: Acceleration of speed Flight of ideas Flowery language DD: schizophrenia,
Delusions : Grandiose Persecutory
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4 subtypes by ICD-10,HypomaniaMania without psychotic symptomsMania with psychotic symptomsManic episodes, unspecified
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1.Hypomania:
Lesser degree of maniaSymptoms as that of mania, but never leads to disruption of
work or social rejectionDiagnostic guide lines: ^ mood & ^ activity- several daysConsiderable interference with work/ social activity is
consistent with hypomania.DD: Hyperthyroidism Anorexia nervosa Agitated depression Severe obsessional symptoms
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2.Mania without psychotic symptoms
mood, uncontrollable excitement with ^energy
overactivity pressure of speech decreased need for sleep loss of social inhibitions unsustained attention marked distractibility grandiosity
^
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Cont….
Perceptual ideas: appreciation of color Preoccupation with fine details of surfaces Subjective hyperacusis Mood : irritable & suspicious
First attack: 15- 30 yrs
Diagnostic guide lines: sym – 1wk
disruption of ordinary & social activities
mood change + ^ energy
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3.Mania with psychotic symptoms
Severe form of mania Inflated self esteem, grandiose ideas, delusions,
irritability, suspiciousness into delusions of persecution,
SEVERE CASES : grandiosity mood: incongruent neutral delusions/hallucinationsDD: schizophrenia
4.Maniac episodes , unspecified.
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DIAGNOSTIC GUIDELINES
ICD-10^moodUndue optimismExcessive energyOver activityDecreased need for sleepInflated self esteem, grandiosityExtravagance in spendingPressure of speechEpisode- 1wk, severe enough to disrupt work 7 social
activities
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DSM-IV
Distinct period of abnormality, persistently elevated mood, expansive, irritable
Mood disturbance with 3 or more sym Symptom do not meet the criteria for a mixed
episode Mood disturbance is sufficiently severe to cause
marked impairment in occupational functioning Symptom are not due to direct physiological
effects of a substance or general medical condition
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TREATMENT
Maniac episodes:
antipsychotics
mood stabiliser
olanzapine
parenteral antipsychotics
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DRUGS
LITHIUM:
Main stay of Rx – acute mania
prophylactic agent
600-900mg/day, initially
TR 0.5- 1mEq/l
Monitor for hypothyroidism
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SODIUM VALPROATE:TR 50 – 100 mcg/ml
20mg/day in divided doses
SE: thrombocytopenia
^ transaminase levels
Pre Rx: CBC
LFT
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CARBAMAZEPINE:400-600mg/day
TR: 4-12mcg/lSE: SJ syndromePre Rx : CBC LFTEnzyme inducer, lowers blood levels of
haloperidol
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LAMOTRIGINE:Adv. Doesn’t require blood level monitoring
Dose 25mg/day X 2wks
Incremental doses, 25mg further
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TOPIRAMATE:
Unique feature- wt loss
25-50mg/day can be given upto 200-300mg/day
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REFERENCES:
J.N.Vyas-Essentials of post-graduate psychiatry Namboodri-Concise text book of Psychiatry DSM-IV, Diagnostic manual ICD-10, Diagnostic manual Niraj Ahuja- Concise text book of Psychiatry Eapen- Essentials of Psychiatry
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THANKS FOR PATIENT LISTENING!!!!!!!!!