Mania is defined as a distinct period of abnormally elevated, expansive, or irritable mood. The document discusses the four subtypes of mania according to ICD-10 including hypomania, mania without psychotic symptoms, mania with psychotic symptoms, and unspecified manic episodes. Treatment options for mania include mood stabilizers like lithium, sodium valproate, carbamazepine, lamotrigine, and topiramate as well as antipsychotics. Diagnosis is based on symptoms lasting at least one week according to diagnostic guidelines from ICD-10 and DSM-IV.

1. MANIA
Dr Madhura.T.K.

2.  Definition:
Distinct period during which there is
abnormally persisting elevated, expansive
or irritable mood.
Mood disorders – syndrome, with cluster of
signs & symptoms

3. Common underlying characteristics
• Elevated mood
• Increase in quantity & speed of physical &
mental activity

4. Clinical features
MOOD:
Elevated, feels on the top of the world
Feeling of intense well being
Irritability, outbursts of unprovoked anger
:

5. 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

6. Cont…..
 Bodily sym. ^ appetite
decreased need for sleep
^sexual need

7.  IMPACT ON PSYCHOLOGICAL
FUNCTIONS:
 Thinking: Acceleration of speed
Flight of ideas
Flowery language
DD: schizophrenia,
 Delusions : Grandiose
Persecutory

8. 4 subtypes by ICD-10,
 Hypomania
 Mania without psychotic symptoms
 Mania with psychotic symptoms
 Manic episodes, unspecified

9. 1.Hypomania:
Lesser degree of mania
Symptoms as that of mania, but never leads to disruption of
work or social rejection
Diagnostic guide lines: ^ mood & ^ activity- several days
Considerable interference with work/ social activity is
consistent with hypomania.
DD: Hyperthyroidism
Anorexia nervosa
Agitated depression
Severe obsessional symptoms

10. 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

11. 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

12. 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/hallucinations
DD: schizophrenia
4.Maniac episodes , unspecified.

13. DIAGNOSTIC GUIDELINES
ICD-10
^mood
Undue optimism
Excessive energy
Over activity
Decreased need for sleep
Inflated self esteem, grandiosity
Extravagance in spending
Pressure of speech
Episode- 1wk, severe enough to disrupt work 7
social activities

14. 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

15. TREATMENT
 Maniac episodes:
antipsychotics
mood stabiliser
olanzapine
parenteral antipsychotics

16. DRUGS
 LITHIUM:
Main stay of Rx – acute mania
prophylactic agent
600-900mg/day, initially
TR 0.5- 1mEq/l
Monitor for hypothyroidism

17.  SODIUM VALPROATE:
TR 50 – 100 mcg/ml
20mg/day in divided doses
SE: thrombocytopenia
^ transaminase levels
Pre Rx: CBC
LFT

18.  CARBAMAZEPINE:
400-600mg/day
TR: 4-12mcg/l
SE: SJ syndrome
Pre Rx : CBC
LFT
Enzyme inducer, lowers blood levels of
haloperidol

19.  LAMOTRIGINE:
Adv. Doesn’t require blood level
monitoring
Dose 25mg/day X 2wks
Incremental doses, 25mg further

20.  TOPIRAMATE:
Unique feature- wt loss
25-50mg/day can be given upto
200-300mg/day

21. 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

22. THANKS FOR PATIENT
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