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Calming the Bipolar Storm: Treating Acute Mania and Mixed Episodes in Patients with Bipolar Disorder

Published online by Cambridge University Press:  07 November 2014

John M. Zajecka*
Affiliation:
Dr. Zajecka is associate professor of psychiatry and clinical director of the Treatment Research Center in the Department of Psychiatry at Rush University Medical Center in Chicago, Illinois, and Rush North Shore Medical Center in Skokie, Illinois. He is a consultant to and on the advisory boards of Abbott, Bristol-Myers Squibb, Eli Lilly, and Wyeth; is on the speaker&s bureaus of Abbott, AstraZeneca, Bristol-Myers Squibb, Cyberonics, Eli Lilly, GlaxoSmithKline, Pfizer, and Wyeth; and receives grant/research support from AstraZeneca, Bristol-Myers Squibb, Forest, Novartis, Ortho-McNeil, and Somaxon.

Abstract

Bipolar disorder is a seriously debilitating psychiatric disorder that greatly affects patients and their loved ones. Although bipolar disorder is one of the most frequently occurring mental disorders worldwide, many patients, particularly those with mixed mania, remain misdiagnosed. Compared to pure mania, mixed episodes of bipolar disorder present with symptoms that can be more challenging to treat. However, proper diagnosis and early treatment can usually alter the course of the illness, and remission is certainly possible.

This expert roundtable supplement reviews the differences between acute manic and mixed episodes in patients with bipolar disorder, explains proper dosing and the advantages of different dosage formulations, and identifies the rationale for monotherapy and combination therapy in these patient populations. The aim is to educate clinicians about ways to diagnose and treat the mood state aggressively and safely, especially in light of the many new treatment options available.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2007

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References

1.RC, Kessler, Berglund, P, Demler, O, Jin, R, KR, Merikangas, EE, Walters. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593602. Erratum in: Arch Gen Psychiatry. 2005;62(7):768.Google Scholar
2.Kruger, S, Trevor Young, L, Braunig, P. Pharmacotherapy of bipolar mixed states. Bipolar Disord. 2005;7(3):205–15.CrossRefGoogle ScholarPubMed
3.Calabrese, JR, Shelton, MD, Bowden, CL, et al.Bipolar rapid cycling: focus on depression as its hallmark. J Clin Psychiatry. 2001;62(suppl 14):3441.Google ScholarPubMed
4.Akiskal, HS, Walker, P, Puzantian, VR, King, D, Rosenthal, TL, Dranon, M. Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors. J Affect Disord. 1983;5(2):115–28.CrossRefGoogle ScholarPubMed
5.Geller, B, Luby, J. Child and adolescent bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1997;36(9):11681176.CrossRefGoogle ScholarPubMed
6.Swann, AC, Geller, B, Post, RM, et al.Practical clues to early recognition of bipolar disorder: A primary care approach. Prim Care Companion J Clin Psychiatry. 2005;7(1):1521.Google ScholarPubMed
7.Suppes, T, Mintz, J, SL, McElroyMixed hypomania in 908 patients with bipolar disorder evaluated prospectively in the Stanley Foundation Bipolar Treatment Network: a sex-specific phenomenon. Arch Gen Psychiatry. 2005;62(10):10891096.CrossRefGoogle ScholarPubMed
8.Swann, AC, Bowden, CL, Morris, D, et al.Depression during mania. Treatment response to lithium or divalproex. Arch Gen Psychiatry. 1997;54(1):3742.CrossRefGoogle ScholarPubMed
9.Shah, NN, Averill, PM, Shack, A. Mixed versus manic bipolar disorder: a comparison of demographic, symptomatic, and treatment differences. Psychiatr Q. 2004;75(2):183196.CrossRefGoogle ScholarPubMed
10.Prien, RF, Himmelhoch, JM, Kupfer, DJ. Treatment of mixed mania. J Affect Disord. 1988;15(1):915.CrossRefGoogle ScholarPubMed
11.Hirschfeld, RM, Calabrese, JR, Weissman, MM, et al.Screening for bipolar disorder in the community. J Clin Psychiatry. 2003;64(1):5359.CrossRefGoogle ScholarPubMed
12.Goldberg, JF, Garno, JL, Portera, L, Leon, AC, Kocsis, JH, Whiteside, JE. Correlates of suicidal ideation in dysphoric mania. J Affect Disord. 1999;56(1):7581.CrossRefGoogle ScholarPubMed
13.Goldberg, JF, Garno, JL, Leon, AC, Kocsis, JH, Portera, L. Association of recurrent suicidal ideation with nonremission from acute mixed mania. Am J Psychiatry. 1998;155(12):17531755.CrossRefGoogle ScholarPubMed
14.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
15.Mulleners, WM, Whitmarsh, TE, Steiner, TJ. Noncompliance may render migraine prophylaxis useless, but once-daily regimens are better. Cephalagia. 1998;18:5256.CrossRefGoogle ScholarPubMed
16.Cramer, JA, Mattson, RH, Prevey, ML, Scheyer, RD, Ouellette, VL. How often is medication taken as prescribed? A novel assessment technique. JAMA. 1989;261(22):32733277. Erratum in: JAMA. 1989;262(11):1472.CrossRefGoogle ScholarPubMed
17.McCabe, MS, Norris, B. ECT versus chlorpromazine in mania. Biol Psychiatry. 1977;12(2):245254.Google ScholarPubMed
18.Black, DW, Winokur, G, Nasrallah, H. Treatment of mania: a naturalistic study of ECT versus lithium in 438 patients. J Clin Psychiatry. 1987;48:132139.Google Scholar
19.Small, JG, Klapper, MH, Kellams, JJ, et al.Electroconvulsive treatment compared with lithium in the management of manic states. Arch Gen Psychiatry. 1988;45(8):727732.CrossRefGoogle ScholarPubMed
20.Milstein, V, Small, JG, Klapper, MH, Small, IF, Miller, MJ, Kellams, JJ. Uni-Versus Bilateral ECT in the Treatment of Mania. Convuls Ther. 1987;3(1):19.Google ScholarPubMed
21.Ketter, TA, ed. Advances in the Treatment of Bipolar Disorders. American Psychiatric Press. 2005:2Google Scholar
22.Physician's Desk Reference. 59th ed. Montvale, NJ. Thomson PDR. 2005.Google Scholar
23.Keck, PE, et al.the Expert Consensus Guideline Series: Treatment of Bipolar Disorder 2004. Postgrad Med Special Report. 2004:1120.Google Scholar
24.Schatzberg, AF, et al.Primary Psychiatry. 2002;9:5977.Google Scholar
25.Schatzberg, AF, et al.Manual of Clinical Psychopharmacology. 4th ed. Washington, DC. American Psychiatric Publishing Inc. 2003.Google Scholar
26.Tohen, M,bBaker, RW, Altshuler, LL. Olanzapine versus divalproex in the treatment of acute mania. Am J Psychiatry. 2002;159(6):10111017. Erratum in: Am J Psychiatry. 2005;7(1):102.CrossRefGoogle ScholarPubMed
27.Strakowski, SM, DelBello, MP, Adler, CM. Comparative efficacy and tolerability of drug treatments for bipolar disorder. CNS Drugs. 2001;15(9):701718.CrossRefGoogle ScholarPubMed
28.Horne, RL, Cunanan, C. Safety and efficacy of switching psychiatric patients from a delayed-release to an extended-release formulation of divalproex sodium. J Clin Psychopharmacol. 2003;23(2):176181.CrossRefGoogle Scholar
29.Bowden, CL, et al.Divalproex sodium extended release versus placebo in the treatment of acute mania. Poster presented at: Annual Meeting of the American Psychiatric Association; May 2006; Toronto, Canada.Google Scholar
30.Weisler, RH, et.al.Extended-release carbamazepine capsules as monotherapy in bipolar disorder : pooled results from two randomised, double-blind, placebo-controlled trials. CNS Drugs. 2006;20(3):219231.CrossRefGoogle ScholarPubMed
31.Sachs, GS, Grossman, F, Ghaemi, SN, Okamoto, A, Bowden, CL. Combination of a mood stabilizer with risperidone or haloperidol for treatment of acute mania: a double-blind, placebo-controlled comparison of efficacy and safety. Am J Psychiatry. 2002;159(7):11461154.CrossRefGoogle ScholarPubMed
32.Delbello, MP, Schwiers, ML, Rosenberg, HL, Strakowski, SM. A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry. 2002;41(10):12161223.CrossRefGoogle ScholarPubMed
33.Nichol, MB, Stimmel, GL, Lange, SC. Factors predicting the use of multiple psychotropic medications. J Clin Psychiatry. 1995;56(2):6066.Google ScholarPubMed
34.Frye, MA, Ketter, TA, Leverich, GS, et al.The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study. J Clin Psychiatry. 2000;61(1):915.CrossRefGoogle ScholarPubMed
35.Dilsaver, SC, Swann, AC, Shoaib, AM, Bowers, TC, Halle, MT. Depressive mania associated with nonresponse to antimanic agents. Am J Psychiatry. 1993;150(10):15481551.Google ScholarPubMed
35.Jaffe, AB, Levine, J. Antipsychotic medication coprescribing in a large state hospital system. Pharmacoepidemiol Drug Saf. 2003;12(1):4148.CrossRefGoogle Scholar