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Treatment Guidelines for Acute Manic and Mixed Episodes of Bipolar Disorder

Published online by Cambridge University Press:  07 November 2014

Mark A. Frye
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Extract

Bipolar disorder is a lifelong condition, and pharmacotherapy is essential to its long-term management. Once a comprehensive diagnostic assessment for acute or mixed mania has been completed, it is important to look at an evidence-based data set to guide treatment selection for mood stabilization.

For most patients, lifetime adherence to pharmacotherapy is necessary for maximal mood stability. Pharmacotherapy is the primary treatment for bipolar disorder, as it has been found to be efficacious in treating acute episodes and preventing future episodes of bipolar I disorder. Combination therapy, including at least one mood stabilizer, may be necessary to treat acute depression and mania and to further prevent both depressive and manic recurrences. The goal is to minimize frequency, duration, and severity of depressive and manic symptoms with a treatment regimen, ideally a combination of pharmacotherapy and psychotherapy, that is positioned to maximize treatment adherence and minimize side effects.

This discussion reviews some treatment guidelines for acute manic and mixed episodes associated with bipolar I disorder. Through the context of a case study, this discussion will attempt to provide an understanding and appreciation of Food and Drug Administration-approved and non-FDA-approved treatments for acute mania. In addition, the impact of alcohol as an example of drugs of abuse and its impact on the presentation of acute mania will be discussed.

Type
Research Article
Information
CNS Spectrums , Volume 14 , Issue S15: Practical Management Strategies for Acute Mania and Mixed Episodes of Bipolar Disorder , December 2009 , pp. 8 - 11
Copyright
Copyright © Cambridge University Press 2009

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References

1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
2.Ketter, TA (ed). Advances in the Treatment of Bipolar Disorder. 2005.Google Scholar
3.Swann, AC, Bowden, CL, Morris, D et al. , Depression during mania. Treatment response to lithium or divalproex. Arch Gen Psychiatry. 1997;54(1):37–42.CrossRefGoogle ScholarPubMed
4.Bradwejn, J, Shriqui, C et al. , Double-blind comparison of the effects of clonazepam and lorazepam in acute mania. J Clin Psychopharmacology. 1990;10:403–408.CrossRefGoogle ScholarPubMed
5.Green, A, Tohen, M, Patel, JK et al. , Clozapine in the treatment of refractory psychotic mania. Am J Psychiatry. 2000;157:982–986.CrossRefGoogle ScholarPubMed
6.Frye, MA, Salloum, IM. Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations. Bipolar Disord. 2006;8:677–685.CrossRefGoogle ScholarPubMed
7.Frye, MA, Ketter, TA, Altshuler, LL, Denicoff, K, Cora Locatelli, G, Post, RM. Clozapine in affective illness: implications for other atypical antipsychotics in the treatment of bipolar disorder. J Affect Disord. 1998;48:91–104.CrossRefGoogle Scholar
8.Regier, DA, Farmar, ME, Rae, DS et al. , Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990;264(19):2511–2518.CrossRefGoogle ScholarPubMed
9.Goodwin, FK, Jamison, KR. Manic Depressive Illness. New York, NY: Oxford University Press; 1990.Google Scholar
10.Lasser, K, Boyd, JW, Woolhandler, S et al. , Smoking and mental illness: A population-based prevalence study. JAMA. 2000;284(20):2606–2610.CrossRefGoogle ScholarPubMed
11.McKowen, JW, Frye, MA, Altshuler, LL, Gitlin, MJ. Patterns of alcohol consumption in bipolar patients comorbid for alcohol abuse or dependence. Bipolar Disord. 2005;7(4):377–381.CrossRefGoogle ScholarPubMed
12.Salloum, IM, Cornelius, JR, Daley, DC et al. , Efficacy of valproate maintenance in patients with bipolar disorder and alcoholism: a double-blind placebo-controlled study. Arch Gen Psychiatry. 2005;62(1):37–45.CrossRefGoogle ScholarPubMed
13.Brown, ES, Garza, M, Carmody, TJ. A randomized, double-blind, placebo-controlled addon trial of quetiapine in outpatients with bipolar disroder and alchol use disorders. J Clin Psychiatry. 2008;69:701–715.CrossRefGoogle Scholar