Bipolar Disorders (MA Frye, Section Editor)

Current Psychiatry Reports

, Volume 14, Issue 6, pp 676-686

First online:

Mania: Diagnosis and Treatment Recommendations

  • Gin S. MalhiAffiliated withCADE Clinic, Department of Psychiatry, Royal North Shore HospitalDiscipline of Psychiatry, Sydney Medical School, The University of Sydney Email author 
  • , Michelle TaniousAffiliated withCADE Clinic, Department of Psychiatry, Royal North Shore HospitalDiscipline of Psychiatry, Sydney Medical School, The University of Sydney
  • , Michael BerkAffiliated withSchool of Medicine, Deakin University

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Abstract

This article provides recommendations for the diagnosis and treatment of mania, which characterizes bipolar I disorder (BD I). Failure to detect mania leads to misdiagnosis and suboptimal treatment. To diagnose mania, clinicians should include a detailed mood history within their assessment of patients presenting with depression, agitation, psychosis or insomnia. With regards to treatment, by synthesizing the findings from recent treatment guidelines, and reviewing relevant literature, this paper has distilled recommendations for both acute and long-term management. Antimanic agents including atypical antipsychotics and traditional mood stabilizers are employed to reduce acute manic symptoms, augmented by benzodiazepines if needed, and in refractory or severe cases with behavioural and/or psychotic disturbance, electroconvulsive therapy may occasionally be necessary. Maintenance/prophylaxis therapy aims to reduce recurrences/relapse, for which the combination of psychological interventions with pharmacotherapy is beneficial as it ensures adherence and monitoring of tolerability.

Keywords

Bipolar disorders Mania Acute Depression Bipolar I disorder BD I Diagnosis Assessment Maintenance Prophylaxis Pharmacotherapy Antimanic agents Antipsychotics Mood stabilizers Psychotherapy Treatment recommendations Guidelines