Manic Episode (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:00 So we want to really think about what kinds of episodes people have.

    00:06 So manic.

    00:07 Manic means a lot of energy.

    00:10 And if I was going to be a manic person, if I was going to be a person who had a manic episode rather, I would be talking like this.

    00:17 And I would really be talking very fast, mania or manic episodes really have so much energy to them that the person almost can't contain that kind of energy.

    00:26 There is so much good in the world.

    00:29 And I'm so in love with all the world.

    00:31 And the weather is perfect, and their mood is so elevated, and you see it in the way they gesture.

    00:38 You hear it in their voice, you see it in the way they stand.

    00:42 This is very different than when we talked about JJ.

    00:46 JJ, who was so sad and collapsed that depression.

    00:53 Mania, manic episodes are the opposite, very persistently elevated, you also see that, what do you mean? What do you mean you're not going to come with me on my vacation? You have to come with me! How come you're not coming with me, all of a sudden, like that, in a manic episode, a person's whole manner might change.

    01:18 And they may become irritable in a quick second.

    01:23 And then this expansive mood I want to buy, I want to buy presents for everybody.

    01:30 I want to do everything for everyone.

    01:33 I think I want to stay up for the next week and knit scarves for all the people who don't have any scarves.

    01:41 It's not realistic.

    01:44 When you have a person who has a manic episode, they are not acting realistically.

    01:50 They cannot, this persistently high mood cannot be maintained without it being a real problem and to a normal functioning human being.

    02:03 It leads to very impaired functioning.

    02:06 People don't want to sleep, they don't want to eat.

    02:08 They don't think they have to drink anything.

    02:11 They want to keep moving.

    02:12 They think they are invincible.

    02:16 And it usually lasts at least a week.

    02:20 So what do we see when we see a manic episode? The first thing you might notice pressured speech.

    02:27 What does that means president speech? Here's a little pressured speech.

    02:32 I really wanted you to come with me.

    02:33 I really, really wanted you to come with me.

    02:35 You wouldn't come with me. Why wouldn't you come with me? I only asked you if you would come with me once or twice.

    02:40 And now, now you're not going to come with me? I can't believe it! Why is that considered pressured speech? Because it's almost as though there's a person in my throat, pushing those words out at you.

    02:54 That's pressured speech.

    02:56 Another thing you might see is this decrease need to sleep.

    03:00 Now, the important thing to understand is that if a person is having a manic episode, they don't sleep, but they're not tired in the morning.

    03:11 There is no normal.

    03:14 Oh, I'm so tired. I didn't sleep last night.

    03:16 I got so much done last night, I cleaned my whole house.

    03:20 And then I went outside and I did all the shopping, there's a 24-hour store that's right down the street.

    03:26 And now I'm ready to go and I'm going to clean the garage.

    03:29 That is where that decreased need to sleep is really different from anything else.

    03:37 Distractibility, they'll start on one thing and switch to another thing and then switch to another thing.

    03:43 So they might start taking apart all the closets.

    03:47 And then halfway through say, "Oh I forgot to go get milk ", go out to go buy milk, and pass by another store and say, "Oh, I actually wanted to do something for the lawn." And meanwhile, if you are living with a person who's having a manic episode, you come home and there is a lot of disruption.

    04:08 In the normal processing of things, you're going to see that they have a lot of what is called psychomotor agitation.

    04:19 So you have a lot of movements, you have psychomotor meaning the way they're moving their body and agitation.

    04:27 Meaning it's you know, it's constant, and they have no control over it because this is a manic episode and there's nothing that they can do about it.

    04:36 But you can see it and you can note it.

    04:41 They are getting very interested in these goal oriented activities.

    04:48 Like I'm going to clean my whole entire house, and then I'm going to clean the garage, and I like to become a librarian.

    04:57 So I think I'm going to go online and see how many courses that I can get involved in because I'm not sleeping anyway, I might as well stay up all night and go to school.

    05:09 This inflated self-esteem is really an important piece.

    05:13 It's important to remember inflated self-esteem is I have always been incredibly smart, like people have not really noticed how smart I am.

    05:26 And now, I think that I can actually be a professor, I don't think I need to get a PhD to be a professor.

    05:34 Because I know all of this already.

    05:37 People aren't seeing it, but I know.

    05:39 So I want you to think about that idea of having that inflated self-esteem.

    05:46 The flight of ideas, and that psychomotor agitation comes together quite frequently.

    05:53 So they start talking to you about one thing and they jump to the next thing, and they jump to the next thing.

    05:59 And it's all wrapped up in almost a bumble bee fury of movement.

    06:06 When you are looking at their activities, these activities are not activities that aren't going anywhere.

    06:13 These are activities that actually have some sort of a purpose.

    06:18 Remember, this is an episode, it is not lasting forever, it's going to last about a week.

    06:25 And we're only going to be looking for three of these symptoms to make sure that we start thinking about maybe this person is having a manic episode.

    06:36 This idea of grandiosity, it's really hard to explain this kind of grandiosity until you hear a person who tells you that they are the smartest person in the whole world, I am a total genius, and no one has ever even come close to matching my intelligence.

    07:00 I own most of the world's intellectual property.

    07:07 Now, that doesn't have to be true when they tell you that it's what they believe is true.

    07:12 This grandiosity is in their mind.

    07:16 So three of these symptoms, makes you think, maybe this is a manic episode.

    07:24 Maybe this person is having a manic episode.

    07:29 But why do we worry about that? A person who's having a manic episode usually really enjoys their mania.

    07:37 It's an important thing to understand.

    07:40 They're not sleeping, but they feel like they're getting a lot accomplished.

    07:44 They feel great about themselves.

    07:46 They want to do good for everyone.

    07:50 Unfortunately, because of this incredible elation, that has taken over, and they are a victim of this elation.

    08:02 They take high risk activities.

    08:05 They may be out way later, they may be speeding because they want to hurry up and get to someplace.

    08:12 It's really important to understand that that elated, grandiosity, that increased self-esteem makes them think that they can do things that they may not be able to do.

    08:25 They might think they can go horseback riding, they may never have done horseback riding before in their lives.

    08:32 But they may have an idea in their head.

    08:34 I can horseback ride.

    08:36 I remember doing it on a video game, and I was great. I was the best.

    08:40 I'm going to go horseback riding and end up really getting injured.

    08:46 So we have to be really careful as we're talking to a person who might be having a manic episode.

    About the Lecture

    The lecture Manic Episode (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Mood Disorders: Major Depressive and Bipolar Disorders (Nursing).

    Included Quiz Questions

    1. The client is talking very fast, often interrupting the nurse.
    2. The client is having difficulty staying in their chair.
    3. The client has offered to take the nurse on vacation with them.
    4. The client is looking down at the ground and sitting very still.
    5. The client is endorsing feeling hopeless and sad.
    1. About a week
    2. One–two days
    3. At least two weeks
    4. About a month
    1. Pressured speech
    2. Decreased need for sleep
    3. Psychomotor agitation
    4. Fatigue
    5. Low self-esteem
    1. “I’ve never been white water rafting before, but I feel like I’d be really good at it! There’s a place that rents out canoes a couple of minutes away!”
    2. “I’ve been taking dance classes for eight years now, I think I’m finally good enough to audition for the local dance troupe.”
    3. “My friends and I are going away for a week to Australia, we’ve been planning it for months!”
    4. “I’ve always been interested in rock climbing, but I’ve never done it before. I’ve been looking into places that offer rock climbing lessons.”

    Author of lecture Manic Episode (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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