Decision model for the acute treatment of mania

Abstract

Decision making in psychiatric diagnosis and treatment has not been evaluated systematically. The authors present a model for treatment of an acute manic episode using a decision analysis software program. Six treatment options were put into the model: lithium, valproate, carbamezepine, electroconvulsive therapy, clonazepam, and neuroleptics. Each treatment was evaluated on three factors, efficacy, tolerability, and cost, using data from the literature and pharmacy and billing information. Output from the computer program identified three top choices among the six options: valproate, carbamazepine, and lithium, with valproate emerging as the first choice using the data we inputted. Depression and Anxiety 4:289–293, 1996/1997.© 1997 Wiley‐Liss, Inc.

Valproate treatment and the risk of hyperandrogenism and polycystic ovaries

“…Its effectiveness and safety for use in combination with lithium have also been reported [22]. Recently, valproate has been proposed by some authors even as a first‐line therapy for bipolar disorder [1,23,24], due to a favorable side‐effect profile. There are reports of lower incidence of side‐effects with valproate in comparison to lithium, based on self‐reports of patients who had been prescribed both medications [25], which could eventually be associated with better compliance to valproate.…”