AJAY Psychiatric c.p
Jul 15, 2015
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