Changing Trends in Treatment of Acute Mania: Experience of a Tertiary Centre Over a Decade

Abstract

We investigated trends over a decade in the prescription of lithium, antiepileptics, and antipsychotic agents at discharge for patients hospitalised for acute mania. We conducted a retrospective review of medical records for 165 inpatients with acute mania who had been hospitalised in Cerrahpaşa Faculty of Medicine, Department of Psychiatry during 2001-2002 and 2011-2012. Among 165 patients, prescription of olanzapine at discharge increased from 3 to 46 % (p < 0.001), while prescription of haloperidol decreased from 55 to 21 % (p < 0.001). Use of other atypical antipsychotics did not change significantly (risperidone decreased from 14 to 11 %, p = 0.5; quetiapine increased from 10 to 16 %, p = 0.2). Use of valproate, carbamazepine, and lithium did not change significantly. Use of electroconvulsive therapy in acute mania decreased by half from 27 to 13 % (p = 0.02). Typical antipsychotics alone or in combination with antiepileptics were the most common treatment regimen at discharge at 2001-2002; while 10 years later, they had been largely replaced by lithium or antiepileptics combined with second generation antipsychotics. Antipsychotic agents remained to be an important component of acute treatment of mania in our practice.

Comparison of Adjunctive Quetiapine Versus Adjunctive Haloperidol in Combination with Sodium Valproate for Treatment of Patients with Mania or Mixed Feature Bipolar I Disorder: A Randomized Double-Blind Clinical Trial Study

“…Considering the proven side effects of the secondgeneration antipsychotics (7), along with trends in prescribing the first-generation antipsychotics added to mood stabilizers (8,13) in the management of acute or mixed bipolar episodes, it was of our special interest to compare the impact of first and second-generation antipsychotics (quetiapine and haloperidol) on the rapid relief of acute symptoms in patients with bipolar I disorder. The present study emerged the key findings that the reduction in the score of YMRS at weeks three and six of the treatment plan among the group of quetiapine receivers was not statistically significant.…”

Extended-release carbamazepine versus lithium in management of acute mania in male inpatients with bipolar I disorder

“…An untreated manic episode lasts about 3 months; therefore, clinicians should not discontinue giving drugs before that time [3,4]. The pharmacological treatment of bipolar disorders is divided into both acute and maintenance phases [5,6]. Bipolar treatment, however, also involves the formulation of different strategies for the patient who is experiencing mania or hypomania or depression [7].…”