Treatment of acute mania
by
Oral T.
Neuro Endocrinol Lett. 2005 Aug;26 Suppl 1:9-25


ABSTRACT

Ohe DSM-IV criteria for mania require: a distinct period that represents a break from pre-morbid functioning, a duration of at least one week, elevated or irritable mood, at least three to four classical manic signs and symptoms and the absence of any physical factors. Although not specifically mentioned in the ICD-10 or the DSM-IV definitions, delusional, hallucinatory, even first-rank, psychotic experiences can occur in mania (Hirschfeld et al, 2003). Acute mania can be subdivided into classical pure mania, mania with mood-congruent or mood-incongruent psychosis, mixed state and rapid-cycling mania. One quarter to two thirds of all manic episodes are associated with delusions, while 13% to 40% are associated with hallucinations. Mixed episode is a complex syndrome which is difficult to diagnose, has the most prolonged duration of bipolar episodes and more frequent psychotic profile than pure mania with high suicidality and poor response to drugs. Mixed state mania has been well known since Kreapelin and listed in classification systems with criteria that include both a manic and a major depressive episode nearly every day for at least a one-week period. On the other hand, mixed-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electro-convulsive therapy or light therapy) should not contribute toward a diagnosis of Bipolar I Disorder (Goodwin & Jamison, 1990). Although, theoretically, mania is supposed to be resolved within 1-3 months even without treatment, psychiatric hospitalization is very common in especially severe cases due to functional impairment. Current treatments for mania aim to control the agitation, impulsivity, aggression and psychotic symptoms and to help patients regain their pre-morbid functionality. However, the clinical management of mania is challenging as most patients show syndromal remission but incomplete functional recovery after the first episode of mania (Tohen et al, 2000).
Mania
Lithium
Valproate
Clozapine
Tamoxifen
Gabapentin
Lamotrigine
Unipolar mania
Protein kinase C
Bipolar disorders
Drugs for bipolars
Lithium prophylaxis
The manic spectrum
Schizoaffective disorder
The many faces of mania
Treatment of acute mania
Genius and psychopathology
Mania: lithium versus divaplroex
Dysthymia, hyperthymia and cyclothymia


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