Mania: Diagnosis and Treatment Recommendations
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.
KeywordsBipolar disorders Mania Acute Depression Bipolar I disorder BD I Diagnosis Assessment Maintenance Prophylaxis Pharmacotherapy Antimanic agents Antipsychotics Mood stabilizers Psychotherapy Treatment recommendations Guidelines
G. S. Malhi: grant/research support from National Health and Medical Research Council, Stanley Medical Research Foundation, AstraZeneca, Eli Lilly, Lundbeck, Pfizer, Servier, and Wyeth; consultant to AstraZeneca, Eli Lilly, Janssen Cilag, Lundbeck, Pfizer, and Servier; payment for lectures from AstraZeneca, Eli Lilly, Janssen Cilag, Lundbeck, Mayo Clinic, Pfizer, Ranbaxy, Servier, and Wyeth; compensation for travel/accommodations/meeting expenses from AstraZeneca, Eli Lilly, Lundbeck, Pfizer, Servier, and Wyeth; and royalties from Oxford University Press and Hodder Arnold; M. Tanious: none; M. Berk: grant/research support from National Institutes of Health, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, MBF Bioscience, Beyond Blue, Geelong Medical Research Foundation, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Organon, Novartis, Mayne Pharma, and Servier; consultant to AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck, Merck, and Servier; payment for lectures from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck, Merck, Pfizer, Sanofi-Synthélabo, Servier, Solvay, and Wyeth; co-inventor on two provisional patents regarding the use of N-acetyl cysteine (NAC) and related compounds for psychiatric indications, assigned to the Mental Health Research Institute; and royalties from Cambridge University Press and Allen & Unwin.
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