AJAY

Psychiatric c.p

MANIA

case

presentation

Presenting complaints

• A 23 yrs unmarried right handed Marathi speaking , Hindu religious male ganesh sankpal, educated B.E ,coming from chinchwad pune with the complaints of

• Irritability • Wandering behaviour • Muttering to self • Suspiciousness• Loudly speak • Auditory hallucination• Grandiosity• Loss of memory • Increased psychomotor activity• Flight of ideas

HISTORY OF ILLNESS

• According to informant pt is k/c/o/ psychiatric illness since 4 years was remain untreated till now

• Patient was shown psychiatric illness in past then he was admitted in hospital 3 years ago but absconded before treatment start since then patient behaviour fluctuatively (having unpredictable ups down )and now as behaviour become unmanageble so he brought to SGH

HISTORY OF ILLNESS

• 4 yrs back his symptoms started within duration of B.E F Y exam period and he was noticed anxious during exam period & he was also noticed to be talking to toself with gesturing of hand when asked him ,then he said its related to study

• He was noticed above symptoms with running on road without any reason ,sudden stop going temple and said ringing bell in my ears

• All this behaviour increased and told repeatedly about his behaviour and parent brought to SGH

• No family history of psychiatric illness

DEFINATION OF MANIA

• Mania refers to a syndrome in which the central features are over activity, mood change (which may be towards elation OR irritability ) and self important ideas

Classification of mania (ICD 10)

• F30 MANIC EPISODE

• F30.0 HYPOMANIA

• F30.1 MANIA WITHOUT PSYCHOTIC SYMPTOMS

• F30.2 MANIA WITH PSYCHOTIC SYMPTOMS

• F30.8 OTHER MANIC EPISODE

• F30.9 MANIC EPISODE UNSPECIFIED

ETIOLOGY

Neurotransmitter and structural hypothesis

Excessive level of nor epinephrine and

dopamine

Imbalance between cholinergic and nor adrenergic system and deficiency of serotonin

Genetic consideration

• Monozygotic (identical) twines have a higher rate of incident than normal siblings and other close relatives

• Common among the family members of

bipolar patient

• First degree relatives 5-10 % chance

• Identical twins with bipolar disorders about 40-70% chance

Psychodynamic theory

• Developmental theorists have hypothesized that faulty family dynamics during during early life are responsible for manic behaviors in later life

Manic episode as a defense against or denial of depression

Clinical features

In book • Elevated ,Expansive OR

irritable mood

• 1)Euphoria

• 2)Elation

• 3)Exaltation

• 4) Ecstasy

In patient • Elation and irritable mood

• 1) irritability

• 2)wandering behaviour

contIn book

• Psychomotor activity increased

• Speech and thought

• Flight of ideas

• Pressure of speech

• Delusion of grandiosity

• Delusion of persecution

• Distractibility

In patient

• Psychomotor activity increased

• Speech and thought

• Flight of ideas

• Delusion of grandiosity

• Big talk

• Speak loudly

cont

In book

• Other features

• increased sociability

• Impulsive behaviour

• Poor judgment

• Decreased sleep

• Absence of insight

• Decreased attention and concentration

In patient

• Other features

• Poor judgment

• Decreased sleep

• Loss of memory (amnesia)

Objective sings and subjective symptoms of manic patient

Objective sings

• Disturbance in speech

• Rapid speech

• Loud ,pressured pressure

• Easily distracted

• Over activity

• Mood lability

• Weight change

Subjective symptoms

• Feeling of joy

• Rapid mood swings

• Sleep disturbance

• Delusion and hallucination