case presntation

1. AJAY
Psychiatric c.p

2. MANIA
case
presentation

3. 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

4. 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

5. 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 to
self 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

6. 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

8. 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

10. ETIOLOGY
Neurotransmitter and structural hypothesis
Excessive level of nor epinephrine and
dopamine
Imbalance between cholinergic and nor
adrenergic system and deficiency of serotonin

11. 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

12. 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

24. 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

25. cont
In 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

26. 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)

40. 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