We generally combine lithium or valproate with aripiprazole, haloperidol, olanzapine, quetiapine, or risperidone. Initial treatment - For patients with severe mania, we suggest initial treatment with lithium plus an antipsychotic however, valproate plus an antipsychotic is a reasonable alternative ( algorithm 1). (See "Acute bipolar mania and hypomania in adults: General principles of pharmacotherapy", section on 'Duration of an adequate trial'.) The duration of an adequate treatment trial is discussed separately. Patients begin with initial treatment and progress through each step until they respond. Severely ill patients generally require hospitalization.Īpproach to treatment - We suggest that acute treatment of severe mania proceed according to the sequence depicted in the algorithm ( algorithm 1) and described in the sections below. SEVERE MANIC EPISODES - Severe episodes of mania or mania with mixed features are medical emergencies that are characterized by suicidal or homicidal ideation or behavior, aggressiveness, psychotic features (eg, delusions or hallucinations), and/or poor judgment that places the patient or others at imminent risk of being harmed. (See "Acute bipolar mania and hypomania in adults: General principles of pharmacotherapy".) These general principles are discussed in detail separately. Similar approach for mania and hypomania.GENERAL TREATMENT PRINCIPLES - The general principles and issues that are involved in treating acute bipolar mania and hypomania include the following: Poor judgment that places the patient or others at imminent risk of being harmed.Psychotic features (ie, delusions or hallucinations).Although there are no established criteria that demarcate severe episodes from mild to moderate illness, we classify episodes as severe if they include any of the following: Pharmacotherapy for manic episodes depends upon their severity. (See "Bipolar disorder in adults: Clinical features" and "Bipolar disorder in adults: Assessment and diagnosis", section on 'Diagnosis'.)ĭespite clinical differences among manic and hypomanic episodes (eg, hypomania is less severe than mania), they are treated with the same medications. Additional information about the clinical features and diagnosis of bipolar disorder is discussed separately. Episodes of mania, hypomania, and major depression can be accompanied by symptoms of the opposite polarity and are referred to as mood episodes with mixed features (eg, mania with mixed features). Bipolar II disorder is marked by at least one hypomanic episode, at least one major depressive episode, and the absence of manic episodes. Patients with bipolar I disorder experience manic episodes and nearly always experience hypomanic and major depressive episodes. The subtypes of bipolar disorder include bipolar I and bipolar II. (See "Acute bipolar mania and hypomania in adults: General principles of pharmacotherapy" and "Bipolar major depression in adults: Choosing treatment" and "Bipolar disorder in adults: Choosing maintenance treatment".)ĭEFINITION OF BIPOLAR DISORDER - Bipolar disorder is characterized by episodes of mania ( table 1), hypomania ( table 2), and major depression ( table 3). The general principles of administering pharmacotherapy for acute mania and hypomania in adults are discussed separately, as are pharmacotherapy for acute bipolar depression and maintenance treatment. This topic reviews choosing pharmacotherapy for acute mania and hypomania in adults. Despite clinical differences between manic and hypomanic episodes, they are treated with the same medications. INTRODUCTION - Bipolar disorder is marked by episodes of mania ( table 1) and hypomania ( table 2), and nearly always includes episodes of major depression ( table 3).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |