Medikamentöse Behandlung akuter Manien

Letmaier, Martin; Schreinzer, D.; Thierry, Nikolaus; Kasper, Siegfried

doi:10.1007/s00115-003-1554-x

Nervenarzt

2004

DOI: 10.1007/s00115-003-1554-x

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Medikamentöse Behandlung akuter Manien

Martin Letmaier

D. Schreinzer

Nikolaus Thierry

et al.

Abstract: The aim of the present retrospective chart analysis was to compare published treatment algorithms with the treatment patterns of 90 consecutive inpatients suffering from acute mania or hypomania at the Department of General Psychiatry, University of Vienna, from 1997 to 1999. Treatment strategies during the first 14 days and on discharge as well as sociodemographic and illness related data were evaluated. The results of our study reflect that international guidelines were not included in daily practice from 19… Show more

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Cited by 4 publications

References 35 publications

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Behandlungsmöglichkeiten der akuten Manie mit atypischen Antipsychotika

Attarbaschi

Kasper

2006

Nervenarzt

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The diagnosis and treatment of bipolar mania are extremely challenging. Therapeutic intervention for mania has traditionally relied on the use of lithium or divalproex as a first-line treatment option. However, due to the limited therapeutic range of these agents, typical neuroleptics have often been used. Although these have demonstrated efficacy in mania, they are often associated with significant side effects, especially extrapyramidal symptoms. Thus, atypical antipsychotics are increasingly preferred in the treatment of bipolar mania. In this review, data from controlled studies for several of the atypical antipsychotics in the treatment of mania are surveyed and issues in the selection of an appropriate atypical agent are discussed.

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Behandlungsmöglichkeiten der akuten Manie mit atypischen Antipsychotika

Attarbaschi

Kasper

2006

Nervenarzt

Self Cite

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Problems of evidence-based medicine in psychopharmacotherapy: problems of evidence grading and of the evidence basis for complex clinical decision making

Möller

Maier

2007

Nervenarzt

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Psychopharmacotherapy should now be regulated in the sense of evidence based medicine, as is the case in other areas of therapeutic medicine. In general, this is a meaningful development which will have a positive impact on routine health care. However, related problems should not be ignored. One important problem is the different definition of degrees of evidence. If placebo-controlled studies are prioritized, evidence deviates too much from the conditions of routine clinical care. However, the restriction to active comparative trials could lead to false conclusions about efficacy. In addition, if the focus is placed on the results of meta-analyses instead of considering relevant single studies, the result is a decision making logic contrary to that of the licensing process.Due to inherent methodological problems of the meta-analytical approach, the narrative, systematic review should retain its traditional importance and be used to provide a complementary view. Attempts to regulate psychopharmacotherapy in the sense of evidence based medicine come closer to their limits the more complex the clinical situation and the respective decision making logic are. Even in times of evidence based medicine, a large part of complex clinical decision making in psychopharmacotherapy still relies more on a consensus about clinical experience and traditions than on relevant empirical databases.

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Typical neuroleptics vs. atypical antipsychotics in the treatment of acute mania in a natural setting

Letmaier

Schreinzer

Reinfried

et al. 2005

Int. J. Neuropsychopharm.

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The present retrospective chart review documents the treatment practice of in-patients suffering from acute manic or hypomanic episodes, at the Department of General Psychiatry, Medical University of Vienna between 1997 and 2001. The aim of the study was to compare the efficacy of typical neuroleptics and atypical antipsychotics as add-on therapy to mood stabilizers. A total of 119 episodes of consecutively admitted patients with ICD-10-defined acute mania (n=106) or hypomania (n=13) were included in a retrospective analysis. Two subgroups were separated out of the whole patient sample according to the medication used: (a) mood stabilizer+typical neuroleptic (n=27) and (b) mood stabilizer+atypical antipsychotic (n=39). The treatment patterns of both subgroups during the first 14 d of in-patient treatment were evaluated. The therapeutic effect was measured by the Clinical Global Impression Scale (CGI). Both patient groups showed no differences on CGI at admission. Patients treated with atypical antipsychotics showed a significantly greater clinical improvement after 14 d (p<0.005) and on discharge (p<0.05) than patients treated with typical neuroleptics. Furthermore, patients treated with atypical antipsychotics developed significantly less extrapyramidal side-effects (p<0.01) and were significantly treated less often with benzodiazepines (p<0.05) during the first 14 d compared to the group receiving typical neuroleptics. Based on our evaluation and the data available in the literature atypical antipsychotics can be considered as first choice for the treatment of acute mania as add-on therapy to mood stabilizers because of their better efficacy and side-effect profile compared to typical neuroleptics.

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Medikamentöse Behandlung akuter Manien

Cited by 4 publications

References 35 publications

Behandlungsmöglichkeiten der akuten Manie mit atypischen Antipsychotika

Behandlungsmöglichkeiten der akuten Manie mit atypischen Antipsychotika

Problems of evidence-based medicine in psychopharmacotherapy: problems of evidence grading and of the evidence basis for complex clinical decision making

Typical neuroleptics vs. atypical antipsychotics in the treatment of acute mania in a natural setting

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