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Consider second-generation antipsychotics for the management of mixed states in bipolar disorder

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Abstract

The diagnosis and treatment of mixed states in bipolar disorder can be challenging. The mainstay of treatment is antipsychotic therapy (± a mood stabilizer), with second-generation antipsychotics emerging as the treatment of choice. When medication fails or cannot be used, electroconvulsive therapy may be effective.

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References

  1. Fagiolini A, Coluccia A, Maina G, et al. Diagnosis, epidemiology and management of mixed states in bipolar disorder. CNS Drugs. 2015;29(9):725–40.

    Article  PubMed  Google Scholar 

  2. Berk M, Dodd S, Malhi GS. ‘Bipolar missed states’: the diagnosis and clinical salience of bipolar mixed states. Aust N Z J Psychiatry. 2005;39(4):215–21.

    PubMed  Google Scholar 

  3. Cassidy F, Murry E, Forest K, et al. Signs and symptoms of mania in pure and mixed episodes. J Affect Disord. 1998;50(2–3):187–201.

    Article  CAS  PubMed  Google Scholar 

  4. Goodwin GM. Evidence-based guidelines for treating bipolar disorder: revised second edition: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2009;23(4):346–88.

    Article  CAS  PubMed  Google Scholar 

  5. Yatham LN, Kennedy SH, O’Donovan C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord. 2005;7(Suppl 3):5–69.

    Article  PubMed  Google Scholar 

  6. Fountoulakis KN, Kontis D, Gonda X, et al. Treatment of mixed bipolar states. Int J Neuropsychopharmacol. 2012;15(7):1015–26.

    Article  CAS  PubMed  Google Scholar 

  7. Keck PE Jr, Marcus R, Tourkodimitris S, et al. A placebo-controlled, double-blind study of the efficacy and safety of aripiprazole in patients with acute bipolar mania. Am J Psychiatry. 2003;160(9):1651–8.

    Article  PubMed  Google Scholar 

  8. Sachs G, Sanchez R, Marcus R, et al. Aripiprazole in the treatment of acute manic or mixed episodes in patients with bipolar I disorder: a 3-week placebo-controlled study. J Psychopharmacol. 2006;20(4):536–46.

    Article  CAS  PubMed  Google Scholar 

  9. Suppes T, Eudicone J, McQuade R, et al. Efficacy and safety of aripiprazole in subpopulations with acute manic or mixed episodes of bipolar I disorder. J Affect Disord. 2008;107(1–3):145–54.

    Article  CAS  PubMed  Google Scholar 

  10. McIntyre RS, Cohen M, Zhao J, et al. A 3-week, randomized, placebo-controlled trial of asenapine in the treatment of acute mania in bipolar mania and mixed states. Bipolar Disord. 2009;11(7):673–86.

    Article  CAS  PubMed  Google Scholar 

  11. McIntyre RS, Cohen M, Zhao J, et al. Asenapine in the treatment of acute mania in bipolar I disorder: a randomized, double-blind, placebo-controlled trial. J Affect Disord. 2010;122(1–2):27–38.

    Article  CAS  PubMed  Google Scholar 

  12. Szegedi A, Zhao J, van Willigenburg A, et al. Effects of asenapine on depressive symptoms in patients with bipolar I disorder experiencing acute manic or mixed episodes: a post hoc analysis of two 3-week clinical trials. BMC Psychiatry. 2011;11:101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Baker RW, Tohen M, Fawcett J, et al. Acute dysphoric mania: treatment response to olanzapine versus placebo. J Clin Psychopharmacol. 2003;23(2):132–7.

    Article  CAS  PubMed  Google Scholar 

  14. Tohen M, Sanger TM, McElroy SL, et al. Olanzapine versus placebo in the treatment of acute mania. Olanzapine HGEH Study Group. Am J Psychiatry. 1999;156(5):702–9.

    CAS  PubMed  Google Scholar 

  15. Tohen M, Jacobs TG, Grundy SL, et al. Efficacy of olanzapine in acute bipolar mania: a double-blind, placebo-controlled study. The Olanzapine HGGW Study Group. Arch Gen Psychiatry. 2000;57(9):841–9.

    Article  CAS  PubMed  Google Scholar 

  16. Baldessarini RJ, Hennen J, Wilson M, et al. Olanzapine versus placebo in acute mania: treatment responses in subgroups. J Clin Psychopharmacol. 2003;23(4):370–6.

    Article  CAS  PubMed  Google Scholar 

  17. Shi L, Schuh LM, Trzepacz PT, et al. Improvement of Positive and Negative Syndrome Scale cognitive score associated with olanzapine treatment of acute mania. Curr Med Res Opin. 2004;20(9):1371–6.

    Article  PubMed  Google Scholar 

  18. Berwaerts J, Xu H, Nuamah I, et al. Evaluation of the efficacy and safety of paliperidone extended-release in the treatment of acute mania: a randomized, double-blind, dose-response study. J Affect Disord. 2012;136(1–2):e51–60.

    Article  CAS  PubMed  Google Scholar 

  19. Vieta E, Nuamah IF, Lim P, et al. A randomized, placebo- and active-controlled study of paliperidone extended release for the treatment of acute manic and mixed episodes of bipolar I disorder. Bipolar Disord. 2010;12(3):230–43.

    Article  CAS  PubMed  Google Scholar 

  20. Khanna S, Vieta E, Lyons B, et al. Risperidone in the treatment of acute mania: double-blind, placebo-controlled study. Br J Psychiatry. 2005;187:229–34.

    Article  PubMed  Google Scholar 

  21. Keck PE Jr, Versiani M, Potkin S, et al. Ziprasidone in the treatment of acute bipolar mania: a three week, placebo-controlled, double-blind, randomized trial. Am J Psychiatry. 2003;160(4):741–8.

    Article  PubMed  Google Scholar 

  22. Stahl S, Lombardo I, Loebel A, et al. Efficacy of ziprasidone in dysphoric mania: pooled analysis of two double-blind studies. J Affect Disord. 2010;122(1–2):39–45.

    Article  CAS  PubMed  Google Scholar 

  23. Potkin SG, Keck PE Jr, Segal S, et al. Ziprasidone in acute bipolar mania: a 21-day randomized, double-blind, placebo-controlled replication trial. J Clin Psychopharmacol. 2005;25(4):301–10.

    Article  CAS  PubMed  Google Scholar 

  24. Weisler RH, Hirschfeld R, Cutler AJ, 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):219–31.

    Article  CAS  PubMed  Google Scholar 

  25. Bowden CL, Brugger AM, Swann AC, et al. Efficacy of divalproex vs lithium and placebo in the treatment of mania. The Depakote Mania Study Group. JAMA. 1994;271(12):918–24.

    Article  CAS  PubMed  Google Scholar 

  26. Bowden CL, Swann AC, Calabrese JR, et al. A randomized, placebo-controlled, multicenter study of divalproex sodium extended release in the treatment of acute mania. J Clin Psychiatry. 2006;67(10):1501–10.

    Article  CAS  PubMed  Google Scholar 

  27. Tohen M, Chengappa KN, Suppes T, et al. Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy. Arch Gen Psychiatry. 2002;59(1):62–9.

    Article  CAS  PubMed  Google Scholar 

  28. Baker RW, Brown E, Akiskal HS, et al. Efficacy of olanzapine combined with valproate or lithium in the treatment of dysphoric mania. Br J Psychiatry. 2004;185:472–8.

    Article  PubMed  Google Scholar 

  29. Houston JP, Ahl J, Meyers AL, et al. Reduced suicidal ideation in bipolar I disorder mixed-episode patients in a placebo-controlled trial of olanzapine combined with lithium or divalproex. J Clin Psychiatry. 2006;67(8):1246–52.

    Article  CAS  PubMed  Google Scholar 

  30. Houston JP, Tohen M, Degenhardt EK, et al. Olanzapine-divalproex combination versus divalproex monotherapy in the treatment of bipolar mixed episodes: a double-blind, placebo-controlled study. J Clin Psychiatry. 2009;70(11):1540–7.

    Article  CAS  PubMed  Google Scholar 

  31. Benazzi F, Berk M, Frye MA, et al. Olanzapine/fluoxetine combination for the treatment of mixed depression in bipolar I disorder: a post hoc analysis. J Clin Psychiatry. 2009;70(10):1424–31.

    Article  CAS  PubMed  Google Scholar 

  32. Tohen M, Vieta E, Calabrese J, et al. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry. 2003;60(11):1079–88.

    Article  CAS  PubMed  Google Scholar 

  33. Sachs GS, Grossman F, Ghaemi SN, et al. 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):1146–54.

    Article  PubMed  Google Scholar 

  34. McIntyre RS, Cohen M, Zhao J, et al. Asenapine for long-term treatment of bipolar disorder: a double-blind 40-week extension study. J Affect Disord. 2010;126(3):358–65.

    Article  CAS  PubMed  Google Scholar 

  35. Tohen M, Calabrese JR, Sachs GS, et al. Randomized, placebo-controlled trial of olanzapine as maintenance therapy in patients with bipolar I disorder responding to acute treatment with olanzapine. Am J Psychiatry. 2006;163(2):247–56.

    Article  PubMed  Google Scholar 

  36. Tohen M, Sutton VK, Calabrese JR, Sachs GS, Bowden CL. Maintenance of response following stabilization of mixed index episodes with olanzapine monotherapy in a randomized, double-blind, placebo-controlled study of bipolar 1 disorder. J Affect Disord. 2009;116(1–2):43–50.

    Article  CAS  PubMed  Google Scholar 

  37. Bowden CL, Collins MA, McElroy SL, et al. Relationship of mania symptomatology to maintenance treatment response with divalproex, lithium, or placebo. Neuropsychopharmacology. 2005;30(10):1932–9.

    Article  CAS  PubMed  Google Scholar 

  38. Suppes T, Vieta E, Liu S, et al. Maintenance treatment for patients with bipolar I disorder: results from a North American study of quetiapine in combination with lithium or divalproex (trial 127). Am J Psychiatry. 2009;166(4):476–88.

    Article  PubMed  Google Scholar 

  39. Vieta E, Suppes T, Eggens I, et al. Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar I disorder (international trial 126). J Affect Disord. 2008;109(3):251–63.

    Article  CAS  PubMed  Google Scholar 

  40. Gruber NP, Dilsaver SC, Shoaib AM, et al. ECT in mixed affective states: a case series. J ECT. 2000;16(2):183–8.

    Article  CAS  PubMed  Google Scholar 

  41. Medda P, Perugi G, Zanello S, et al. Comparative response to electroconvulsive therapy in medication-resistant bipolar I patients with depression and mixed state. J ECT. 2010;26(2):82–6.

    Article  CAS  PubMed  Google Scholar 

  42. Devanand DP, Polanco P, Cruz R, et al. The efficacy of ECT in mixed affective states. J ECT. 2000;16(1):32–7.

    Article  CAS  PubMed  Google Scholar 

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    The article was adapted from CNS Drugs 2015:29(9):725–40 [1] by salaried employees of Adis/Springer and was not supported by any external funding.

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    Adis Medical Writers. Consider second-generation antipsychotics for the management of mixed states in bipolar disorder. Drugs Ther Perspect 32, 249–253 (2016). https://doi.org/10.1007/s40267-016-0295-4

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