Management of acute mania
by
Tohen M, Grundy S
Harvard Medical School,
McLean Hospital, Boston, Mass., USA.
J Clin Psychiatry 1999; 60 Suppl 5:31-4; discussion 35-6
ABSTRACT
Bipolar disorder is a lifelong episodic condition characterized by mood
swings between mania and depression. In the United States alone, approximately 4
million people are affected by this disorder. Pharmacologic treatment for acute
manic episodes or as maintenance therapy includes lithium, valproate,
carbamazepine, and typical antipsychotics. However, many patients fail to
respond to these treatments due to lack of efficacy or production of side
effects leading to patient noncompliance. Non-compliance with pharmacologic
treatment is indeed a major risk factor in bipolar disorder patients and needs
to be managed with ongoing education, psychotherapy, and a simplified but
effective pharmacologic treatment regimen. Recently introduced novel
antipsychotics show much promise as mood-stabilizing agents in bipolar patients,
with minimal risk of treatment-emergent extrapyramidal symptoms and tardive
dyskinesia. Nonetheless, further research is warranted to help clarify the role
of novel antipsychotics in the treatment of bipolar disorder.
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