Comorbidity Subtypes and specifiers for each disorder.
Treatment of Mania An adequate review of effective, evidenced-based psychosocial interventions for bipolar disorder is beyond the scope of this column.
However, the capacity of psychosocial interventions to prevent hospitalization associated with recurrence makes awareness of these interventions crucial to good care. Readers are referred to the works of Miklowitz and colleagues6,7 for a review of the evidence.
There is a growing consensus based on expert opinion,8 published guidelines,9,10 and the STEP-BD reports11,12 that antiepileptics, called mood stabilizers in this context, are preferable both for acute treatment and prevention of recurrence in late-life mania and bipolar disorder depression.
The anticonvulsant divalproex is increasingly considered first choice for treatment and prevention of mania. A Young mania rating scale level is available; while hepatic toxicity is a risk, it is infrequent.
Divalproex inhibits hepatic enzymes that metabolize medications frequently used by older adults. Dose, precautions, and therapeutic levels for other mood stabilizers appear in Table 3.
Due to the delay in the anti-manic effects of mood stabilizers, a 3-week period including titration to a therapeutic range is the minimum time required to establish treatment responsiveness.
In the interim, people whose manic excitement is extreme, exhausting, or overly aggressive will require an antipsychotic or benzodiazepine. As shown in Table 3, numerous atypical antipsychotics are Food and Drug Administration approved for the treatment of mania.
Based on meta-analyses, they appear to be equally superior to placebo13 such that the choice of an individual agent is based on side-effect profiles and patient vulnerabilities.
However, the available data on the treatment of mania in the STEP-BD study as well as the meta-analyses14 includes few older adults.
They must have a current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,17 diagnosis of bipolar disorder, Type 1 manic, mixed, hypomanicbe medically stable, and be free of schizophrenia and dementia.
These patients will be randomized to receive monotherapy with lithium or divalproex with dose titration to be completed within 3 weeks Table 4. Doses are increased or decreased based on side effects as well as therapeutic levels across initial, intermediate, and final target ranges.
Lithium mg or divalproex mg is initiated BID and is adjusted by increasing or decreasing on a step by step basis, with one step equaling one of the twice daily doses.
An increase or decease of one to two steps is made depending upon where the therapeutic level falls in the initial, intermediate, or final range.
Therapeutic levels, side effects, and symptomatic response or lack thereof are obtained on days 4, 9, 15, and 21 following baseline. Blood work to ensure safety is collected at baseline and weeks 3, 6, and 9 and includes complete blood count, transaminases, and amylase.
The onset of diabetes insipidous polyuria, polydipsia may also be cause for discontinuation of lithium. Lorazepam, then risperidone, may be added during the first 3 weeks for as needed use when agitation, aggression, anxiety, hyperactivity, or insomnia are excessive.
Although study results are not expected to appear beforethe GERI-BD protocol provide an expert opinion for aggressive treatment of late-life mania.
Nonetheless, numerous concerns argue for caution when considering lithium for the initiation of treatment. Advanced age, absence of family history of bipolar disorder, mania secondary to another medical condition particularly strokeor dementia predict poor response to lithium.
The age-related decline in renal function means older adults are at increased risk of toxicity because lithium is cleared solely by the kidneys.
Structural brain changes which may not be clinically apparent are associated with higher risk of toxicity. Drug interactions which are less dangerous and less common in younger patients complicate the use of lithium in older adults.
Laboratory tests which should be checked at least annually in patients treated with lithium include fasting blood sugar, thyroid function, creatinine clearance, blood urea nitrogen, and electrolytes.The Young Mania Rating Scale (YMRS) is an item interviewer rated scale ().
Ratings can include other sources of information. Ratings can include other sources of information. The items have five defined grades of severity.
rating scale (Young Mania Rating Scale), was developed to assess severity of symptoms in adults hospitalized for mania. It has been revised in an effort to help clinicians such as pediatricians determine when children.
Schizophrenia. Seroquel is indicated for the treatment of schizophrenia. The efficacy of Seroquel in schizophrenia was established in three 6-week trials in adults and one 6 . Delhi Public School Gautam Buddh Nagar is a under aegis of DPS Society. DPS GBN is affiliated to the CBSE and ranked parent's favorite and one of the best schools on NOIDA Expressway Schools. Pharmacologic and psychosocial treatment options for mania have improved substantially as evidenced by the volume of expert opinion, guidelines, meta-analyses and reports from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study.
Delhi Public School Gautam Buddh Nagar is a under aegis of DPS Society. DPS GBN is affiliated to the CBSE and ranked parent's favorite and one of the best schools on NOIDA Expressway Schools.
INTRODUCTION. Bipolar disorder is marked by episodes of mania and hypomania (), and nearly always includes episodes of major depression .Despite clinical differences between manic and hypomanic episodes, for the purpose of treatment they are considered to be similar and thus treated with the same medications .This topic reviews pharmacotherapy for acute mania and hypomania in adults.
The following diagnostic systems and rating scales are used in psychiatry and clinical psychology. Good information, informed consent and support.
Children and young people and their families need good information, given as part of a collaborative and supportive relationship with healthcare professionals, and need to be able to give fully informed consent.  Healthcare professionals involved in the detection, assessment or treatment of children or young people.