Understanding mania

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Monday, February 17, 2014


MOST of us are familiar with the phenomenon of depression: that kind of blue feeling that makes one weep in tears.

The feeling of sadness does not always mean one has loosened his or her screws.

But once this feeling becomes regular and pervasive, that it gets in the way of everyday living, consultation with a mental health professional may be a course best taken.

In psychiatric practice, depression is classified as a mood disorder.

On the other hand, mania, which is also a mood disorder, is the opposite of depression.

Actually, mania is derived from the Greek word for madness.

This description of an elevated mood was identified in mankind as early as the 5th Century B.C. by Hippocrates.

At present time, mania is a psychiatric condition that coexists with depression as in bipolar disorders, wherein a person slides back and forth depression and mania.

According to sources, mania (or a manic episode) may be described as euphoric, unusually good, cheerful or “high.”

Furthermore, this expansive quality of the mood is characterized by unceasing and indiscriminate enthusiasm for interpersonal, sexual or occupational interactions.

One good example shared by the Diagnostic and Statistical Manual of Mental Disorders 4th edition-Text revision (DSM-IVTR), was that of a person who spontaneously strikes extensive conversation with a stranger in public places.

What is striking in the mood of a person with manic episode is the predominance of irritability whenever the wishes of the person experiencing mania are thwarted.

Pressing further, the person in a manic state also demonstrates distractibility, which is manifested as the inability to screen out irrelevant external stimuli (example, being hypersensitive to the conversations of strangers in a hallway).

This feeling of elation may also be accompanied by an inflated self-esteem. Meaning, the manic person has uncritical self-confidence to marked grandiosity that usually reaches delusional proportions.

Likewise, a manic person has decreased sleep (feeling rested after three hours of sleep only) and racing thoughts faster than can be articulated.

These thoughts are further described as “flight of ideas” meaning, there is continuous flow of accelerated speech with abrupt changes from one topic to another.

In severe flight of ideas, speech becomes disorganized and incoherent.

Overall, the combination of these distorted thoughts and behaviors lead to poor judgment that places the manic person at risk for the following: imprudent involvement in pleasurable activities such as buying sprees, reckless driving, foolish business investments that may have painful consequences; unusual sexual behavior that may include infidelity or indiscriminate sexual encounters with strangers; and impairment in occupational functioning or in usual social activities or relationships with others.

In worst scenarios, the manic person may need to be admitted to a mental health facility to prevent harming self or others.

As a matter of fact, in cases of bipolar disorders, once mania surfaces, the person may exhibit psychotic-like symptoms.

On the contrary, if admission is unnecessary, the person may be experiencing ‘hypomania,’ which is a milder version of mania that it does not also cause marked impairment in occupational and social relationships.

Literatures inform that mania is predominantly genetic or physiologic in origin and that psychosocial theories to explain causes have declined in the recent decades.

Psychiatrists manage this kind of mental disorder by administering Lithium, an anti-manic drug. It also remains the gold standard in pharmacologic treatment of mania.

However, other psychiatrists also consider anticonvulsants as mood stabilizers like carbamezipine that is also used for children with seizures.

For psychiatric nurses, however, interventions are related to specific behaviors manifested by the manic patient.

For example, if the patient manifests extreme hyperactivity that places him or her at risk for injury, management may include the following: reduction of external stimuli; removing hazardous objects and substances within reach; and provision of structured or scheduled list of activities to provide time for rest.

If the manic person demonstrates weight loss, it is appropriate that they be provided with high protein and high caloric food and drinks that are “on-the run.”

To ensure that the person consumes his meal, try eating together.

Lastly, if the manic person manifests impaired social interaction, the best interventions are: set limits to manipulative behaviors; do not argue or bargain with this person; provide positive reinforcement for non-manipulative behaviors; and help this person recognize positive aspects of self.

Sources: Diagnostic and Statistical Manual of Mental Disorders 4th ed-Text revision; Focus on Nursing Pharmacology; The Hypomania Handbook; Essentials of Psychiatric Nursing; Psychiatric and Mental Health Nursing

[Email: polo.medical.sociologist@gmail.com]

Published in the Sun.Star Cagayan de Oro newspaper on February 18, 2014.

Lifestyle

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