Journal articles: 'Acute mania'

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Holtzer, Christopher D., and Stephen A. Echaves. "Valproate in the Treatment of Acute Mania." Journal of Pharmacy Technology 12, no. 1 (January 1996): 6–11. http://dx.doi.org/10.1177/875512259601200104.

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Objective: To determine whether valproate is effective for the acute treatment of mania. Data Sources: Pertinent literature was identified through a MEDLINE search. Study Selection: Blinded, controlled, or other high-quality trials with adequate sample size evaluating valproate in the treatment of acute mania were selected. Data Extraction: Study selection for the review was based on the quality of the trial and the clinical endpoint of control of acute manic symptoms using valproate. Data Synthesis: Acute manic episodes in bipolar disease are disabling and dangerous. A minority of acutely manic patients either do not respond to treatment with lithium or cannot tolerate its adverse effects. Valproate is a viable but slightly less effective alternative in the patients who cannot use lithium. Conclusions: Combined analysis of all studies examined in this article yields a success rate of 54% for valproate in the treatment of acute mania. This efficacy rate recommends valproate as suitable alternative treatment for acutely manic patients who do not respond to lithium or cannot tolerate its adverse effects.

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Yatham, Lakshmi N., Peter F. Liddle, Jonathan Erez, Marcia Kauer-Sant'Anna, Raymond W. Lam, Miguel Imperial, Vesna Sossi, and Thomas J. Ruth. "Brain serotonin-2 receptors in acute mania." British Journal of Psychiatry 196, no. 1 (January 2010): 47–51. http://dx.doi.org/10.1192/bjp.bp.108.057919.

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BackgroundAlthough 5-hydroxytryptamine (5-HT) has been implicated in mania, the precise alterations in the 5-HT system remain elusive.AimsTo assess brain 5-HT2 receptors in drug-free individuals experiencing a manic episode in comparison with healthy volunteers using positron emission tomography (PET).MethodParticipants (n = 10) with DSM–IV bipolar I disorder – manic episode and healthy controls (n = 10) underwent [18F]- setoperone scans. The differences in 5-HT2 receptor binding potential between the two groups were determined using statistical parametric mapping (SPM) analysis.ResultsAge was a significant correlate with 5-HT2 receptor binding potential with a similar magnitude of correlation in both groups. The SPM analysis with age as a covariate showed that the individuals with current mania had significantly lower 5-HT2 receptor binding potential in frontal, temporal, parietal and occipital cortical regions, with changes more prominent in the right cortical regions compared with controls.ConclusionsThis study suggests that brain 5-HT∗2 receptors are decreased in people with acute mania.

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Frye, Mark A. "Treatment Guidelines for Acute Manic and Mixed Episodes of Bipolar Disorder." CNS Spectrums 14, S15 (December 2009): 8–11. http://dx.doi.org/10.1017/s1092852900004028.

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Bipolar disorder is a lifelong condition, and pharmacotherapy is essential to its long-term management. Once a comprehensive diagnostic assessment for acute or mixed mania has been completed, it is important to look at an evidence-based data set to guide treatment selection for mood stabilization.For most patients, lifetime adherence to pharmacotherapy is necessary for maximal mood stability. Pharmacotherapy is the primary treatment for bipolar disorder, as it has been found to be efficacious in treating acute episodes and preventing future episodes of bipolar I disorder. Combination therapy, including at least one mood stabilizer, may be necessary to treat acute depression and mania and to further prevent both depressive and manic recurrences. The goal is to minimize frequency, duration, and severity of depressive and manic symptoms with a treatment regimen, ideally a combination of pharmacotherapy and psychotherapy, that is positioned to maximize treatment adherence and minimize side effects.This discussion reviews some treatment guidelines for acute manic and mixed episodes associated with bipolar I disorder. Through the context of a case study, this discussion will attempt to provide an understanding and appreciation of Food and Drug Administration-approved and non-FDA-approved treatments for acute mania. In addition, the impact of alcohol as an example of drugs of abuse and its impact on the presentation of acute mania will be discussed.

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Duman, Berker, Adnan Kuşman, Burçin Çolak, Filiz Çay Şenler, and Hakan Kumbasar. "Tamoxifen-induced acute mania: A case report." Journal of Oncology Pharmacy Practice 26, no. 8 (April 11, 2020): 2025–27. http://dx.doi.org/10.1177/1078155220915959.

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Introduction Tamoxifen is widely used for the treatment of hormone-responsive breast cancer, osteoporosis, and post-menopausal symptoms. Also, tamoxifen is currently under investigation for its anti-manic properties. In this article, we report a case who developed manic episode following the initiation of tamoxifen and remitted with discontinuation of the medication. Case Report A 58-year-old woman was diagnosed with breast cancer. Pathologic diagnosis was invasive ductal carcinoma. Following bilateral total mastectomy operation, trastuzumab was initiated with intervals of 21 days. Five days before the fourth application of trastuzumab, tamoxifen was added. On the sixth day following the initiation of tamoxifen, manic symptoms were developed and she was diagnosed as acute mania. Management and Outcome The oncology department suggested withdrawing tamoxifen due to a possible association between tamoxifen initiation and behavioral symptoms. Manic symptoms were rapidly (approximately 24 h) improved following cessation of tamoxifen. Psychiatric evaluation on the fifth day following cessation of tamoxifen revealed no manic symptoms. An aromatase inhibitor-exemestane was initiated and she showed no side effects with this medication since then. Discussion To our knowledge, this is the first case report of probable tamoxifen-induced mania. Our case report at least indicates that there were possibly some patients who were sensitive to the tamoxifen’s nervous system effects, mainly to manic effects. In conclusion, clinicians should be aware of these rare behavioral adverse effects of tamoxifen.

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Khanna, Sumant, Eduard Vieta, Benjamin Lyons, Fred Grossman, Mariëlle Eerdekens, and Michelle Kramer. "Risperidone in the treatment of acute mania." British Journal of Psychiatry 187, no. 3 (September 2005): 229–34. http://dx.doi.org/10.1192/bjp.187.3.229.

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BackgroundSevere mania is life-threatening, carries an increased risk of suicide and has a serious impact on patients and their families. Efficient and rapid control of episodes of acute mania is needed.AimsTo evaluate the safety and efficacy of risperidone monotherapy for acute mania.MethodIn a 3-week, randomised, double-blind trial, 290 in-patients with bipolar l disorder with current manic or mixed episode and a baseline Young Mania Rating Scale (YMRS) score of 20 or more received flexible doses of risperidone (1–6 mg per day) or placebo.ResultsRisperidone was received by 146 patients and placebo by 144. Their mean baselineYMRS score was 37. 2 (s. e. =0. 5). Significantly greater improvements were observed with risperidone than with placebo at weeks l and 2 and at end-point (total YMRS: P<0. 01). Extrapyramidal symptoms were the most frequently reported adverse events in the risperidone group.ConclusionsIn patients with severe manic symptoms, risperidone produced significant improvements in YMRS scores as early as week 1 and substantial changes at end-point. Treatment was well tolerated.

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Thomas, Pierre. "Treatment options for acute mania." European Psychiatry 18, S1 (December 2003): 13s—18s. http://dx.doi.org/10.1016/s0924-9338(03)80011-1.

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Mood disorders that have no medical or pharmacological causes are divided into depressive disorders (unipolar, or major depressive disorder) and bipolar disorders. In bipolar disorders, both depressive and manic episodes occur sequentially.A manic episode is characterised as an abnormally excited mood that is experienced by a patient for a distinct period (at least a week). Diagnosis of mania requires that a patient’s work and social life be significantly affected, or that the patient needs hospitalisation. Diagnosis also requires the presence of three or more of the following symptoms: inflated self-esteem or grandiosity; decreased need for sleep; increased talkativeness; racing thoughts/ideas; distraction; increased goal-directed activity; excessive involvement in pleasurable activities [1].

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Zajecka, John M. "Acute Mania." Psychiatric Annals 33, no. 12 (December 1, 2003): 786–95. http://dx.doi.org/10.3928/0048-5713-20031201-06.

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Dose, Matthias, and Hinderk M. Emrich. "Acute Mania." CNS Drugs 3, no. 6 (June 1995): 427–35. http://dx.doi.org/10.2165/00023210-199503060-00003.

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van Rossum, Inge, Josep Maria Haro, Diederik Tenback, Maarten Boomsma, Iris Goetz, Eduard Vieta, and Jim van Os. "Stability and treatment outcome of distinct classes of mania." European Psychiatry 23, no. 5 (August 2008): 360–67. http://dx.doi.org/10.1016/j.eurpsy.2008.02.005.

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AbstractBackgroundPsychopathological heterogeneity in manic syndromes may in part reflect underlying latent classes with characteristic outcome patterns. Differential treatment course and outcome after 12 weeks of treatment were examined for three distinct classes of patients with acute mania in bipolar disorder.Subjects and methodsThree thousand four hundred and twenty-five patients with acute mania were divided into three distinct mania classes: ‘Typical’, ‘Psychotic’ and ‘Dual’ (i.e. comorbid substance use) mania. Persistence of class differences and social outcomes were examined, using multilevel regression analyses and odds ratios.ResultsThe three classes showed substantial stability post-baseline in the pattern of associations with class-characteristic variables. Psychotic and Dual mania predicted poorer outcome in terms of psychosis comorbidity and overall bipolar and mania severity, while Dual mania additionally predicted poorer outcome of alcohol and substance abuse. Worse social outcomes were observed for both Dual and Psychotic mania.ConclusionThe identified distinct classes are stable and associated with differential treatment outcome. Overall, Dual and Psychotic mania show less favourable outcomes compared to Typical mania. These findings additionally give rise to concern on the generalisability of randomized clinical trials RCTs.

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Ghabi, H., M. Karoui, S. Ben Salem, R. Kamoun, and F. Ellouz. "Acute mania in patient under tamoxifen." European Psychiatry 64, S1 (April 2021): S433. http://dx.doi.org/10.1192/j.eurpsy.2021.1155.

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IntroductionTamoxifen is an antioestrogen agent used in breast cancer treatment. According to some guidelines, this molecular was also proposed for the treatment of acute mania. In fact, Tamoxifen inhibits the intracellular action of the protein kinase C (PKC), which is the direct target in the treatment of mania episodes. Lithium and valproate have also the same action.ObjectivesWe aimed to show the case of an acute mania under an inhibitor PKC treatment and insisted that other studies are recommended.MethodsCase report description and research on medline, pubmed with the keywords: Tamoxifen, Bipolar disorder, protein kinase C,mania.ResultsWe reported a case of a 53-year-old woman with past history of unipolar depression. In 2018 when she was diagnosed with breast cancer. She received antidepressant drugs but she interrupted the treatment after a few months. She was treated for her breast cancer with mastectomy, radiotherapy, and 20 mg per day of Tamoxifen prescribed since Mars 2018. She had been admitted in June 2019 in our department for acute mania. The patient received Tamoxifen as it was prescribed. She was not taking any concomitant medications. No history of drug abuse was reported. Medical examination, laboratory, and radiological investigations did not indicate any medical pathology.ConclusionsIn our case, Tamoxifen had not ovoid the acute mania in spite of its Known anti-manic properties as reported in the literature. Possible neurobiological effect of tamoxifen on the nervous system should be studied to evaluate the safety of this treatment mainly in patients with bipolar disorder.

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Lopes, R., J. Azevedo, R. Curral, M. Esteves, R. Coelho, and A. Roma-Torres. "P01-225-A case of unipolar mania." European Psychiatry 26, S2 (March 2011): 226. http://dx.doi.org/10.1016/s0924-9338(11)71936-8.

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IntroductionThe concept of unipolar mania has been raised, rejected and resurrected by a number of authors, and its true position within bipolar affective disorders is still a subject of debate.Clinical caseA 52-year-old Caucasian woman was presented to the emergency room accompanied by family members because she had seven days without sleeping, exaggerated self-confidence and was engaged in multiple activities.DiscussionAt the mental examination she presented irritability, agitation, elation of mood, verbiage, sexual disinhibition, delusional activity of persecutory content, absence of insight. She had three manic episodes earlier and she didn’t have therapeutic adherence. The patient maintained an optimal level of performance functioning between maniac episodes, and also had no earlier depressive episodes. She described herself as a very creative, original, friendly, outgoing, sociable, responsible person. She had no family history of bipolar disease or other psychiatric disorder. An hemogram, basic biochemical investigations, cerebral TC, ilicits drugs screen and EEG were preformed showing no relevant alterations. She was admitted at an acute care psychiatric unit for 16 days. She had a good response to risperidone 2 mg and 1000 mg of divalproex sodium and to cognitive behavioural treatment.ConclusionDue to her previous 3 and her current manic episodes, without history of depressive symptoms, we concluded by the diagnosis of unipolar mania. Although there are certain sociodemographic and clinical variables that overlap, there does seem to be recent evidence concerning clinical, psychopathological and treatment features indicating a nosological separation of unipolar mania from bipolar mania.

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Beckett, Jonathan, and Robert Chaplin. "Capacity to consent to treatment in patients with acute mania." Psychiatric Bulletin 30, no. 11 (November 2006): 419–22. http://dx.doi.org/10.1192/pb.30.11.419.

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Aims and MethodThis study aimed to determine the proportion of patients hospitalised with mania who had capacity to consent to treatment, to determine the predictors of capacity and to explore the relationship between detained status and capacity. Fifty in-patients with mania participated in a clinical interview to assess capacity.ResultsNineteen patients (38%) had overall capacity. Capacity was predicted by higher IQ, lower severity of manic symptoms and more episodes of depression; it was not related to voluntary or detained status. The domains of capacity were not hierarchical.Clinical ImplicationsMany patients hospitalised with mania have capacity to make an informed choice regarding treatment even when compulsorily detained. Their capacity should be reviewed frequently and measures adopted to enhance capacity.

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Yu, Chia-Ling, Andre F. Carvalho, Trevor Thompson, Tzu-Cheng Tsai, Ping-Tao Tseng, Chih-Wei Hsu, Tien-Wei Hsu, and Chih-Sung Liang. "Comparison of antipsychotic dose equivalents for acute bipolar mania and schizophrenia." BMJ Mental Health 26, no. 1 (February 2023): e300546. http://dx.doi.org/10.1136/bmjment-2022-300546.

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QuestionAre antipsychotic dose equivalents between acute mania and schizophrenia the same?Study selection and analysisSix databases were systematically searched (from inception to 17 September 2022) to identify blinded randomised controlled trials (RCTs) that used a flexible-dose oral antipsychotic drug for patients with acute mania. The mean and SD of the effective dose and the pre–post changes in manic symptoms were extracted. A network meta-analysis (NMA) under a frequentist framework was performed to examine the comparative efficacy between the antipsychotics. A classic mean dose method (sample size weighted) was used to calculate each antipsychotic dose equivalent to 1 mg/day olanzapine for acute mania. The antipsychotic dose equivalents of acute mania were compared with published data for schizophrenia.FindingsWe included 42 RCTs which enrolled 11 396 participants with acute mania. The NMA showed that risperidone was superior to olanzapine (reported standardised mean difference: −022, 95% CI −0.41 to –0.02), while brexpiprazole was inferior to olanzapine (standardised mean difference: 0.36, 95% CI 0.08 to 0.64). The dose equivalents to olanzapine (with SD) were 0.68 (0.23) for haloperidol, 0.32 (0.07) for risperidone, 0.60 (0.11) for paliperidone, 8.00 (1.41) for ziprasidone, 41.46 (5.98) for quetiapine, 1.65 (0.32) for aripiprazole, 1.23 (0.20) for asenapine, 0.53 (0.14) for cariprazine and 0.22 (0.03) for brexpiprazole. Compared with the olanzapine dose equivalents for schizophrenia, those of acute mania were higher for quetiapine (p<0.001, 28.5%) and aripiprazole (p<0.001, 17.0%), but lower for haloperidol (p<0.001, –8.1%) and risperidone (p<0.001, –15.8%).ConclusionsAntipsychotic drugs have been considered first-line treatment for acute mania, warranting specific dose equivalence for scientific and clinical purposes.

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Huang, Yu-Jui, Shang-Ying Tsai, Kuo-Hsuan Chung, Pao-Huan Chen, Shou-Hung Huang, and Chian-Jue Kuo. "State-dependent alterations of lipid profiles in patients with bipolar disorder." International Journal of Psychiatry in Medicine 53, no. 4 (December 27, 2017): 273–81. http://dx.doi.org/10.1177/0091217417749786.

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Objective Serum lipid levels may be associated with the affective severity of bipolar disorder, but data on lipid profiles in Asian patients with bipolar disorder and the lipid alterations in different states of opposite polarities are scant. We investigated the lipid profiles of patients in the acute affective, partial, and full remission state in bipolar mania and depression. Methods The physically healthy patients aged between 18 and 45 years with bipolar I disorder, as well as age-matched healthy normal controls were enrolled. We compared the fasting blood levels of glucose, cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein of manic or depressed patients in the acute phase and subsequent partial and full remission with those of their normal controls. Results A total of 32 bipolar manic patients (12 women and 20 men), 32 bipolar depressed participants (18 women and 14 men), and 64 healthy control participants took part in this study. The mean cholesterol level in acute mania was significantly lower than that in acute depression (p < 0.025). The lowest rate of dyslipidemia (hypertriglyceridemia or low high-density lipoprotein cholesterol) was observed in acute bipolar mania. Conclusion Circulating lipid profiles may be easily affected by affective states. The acute manic state may be accompanied by state-dependent lower cholesterol and triglyceride levels relative to that in other mood states.

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Ortega, M. "Post-stroke mania." European Psychiatry 65, S1 (June 2022): S290—S291. http://dx.doi.org/10.1192/j.eurpsy.2022.742.

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Introduction Approximately one-third of stroke survivors develop poststroke depression. Post-stroke mania is relatively rare, with a prevalence of less than 2%. One review of case reports of late-onset mania in 2015 demonstrated that 51% of the patients had established vascular risk factors. In 28% of cases, the treatment of underlying organic cause contributed to successful remission of the manic episode. Objectives For this review, we aimed to compile published case reports from the past 20 years to review late-onset mania as one of the neuropsychiatric outcomes of stroke and its management. Methods literature search on Pubmed, PsychInfo, and Embase utilizing keywords combinations: Bipolar, Manic, Mania, Secondary, Stroke, Poststroke, Post-stroke, Elderly, Old, Late onset, Late-onset, Lateonset, Hemisphere, Brain, Vascular, Infarction. Results Among the 17 case reports, the age of onset of manic episode ranged from 47 to 86 with a mean of 67 years. Of the 17 cases, the right hemisphere was the most frequently affected (14/17, 82%), with cerebrovascular lesion involving the left hemisphere in 3 cases (17.6%). Conclusions Clinicians should consider mania secondary to an organic cause in patients presenting with focal or soft neurological signs or symptoms, manic episode with atypical symptoms such as visual or olfactory hallucinations, altered mental status, disorientation, impairment in memory or cognition, unusual age of onset for bipolar disorder, or unusual illness course such as single episode of mania or poor response to psychopharmacologic treatment. Some reviews suggest combination of mood stabilizers and second-generation antipsychotics. Benzodiazepines recommended as an adjunctive drug for acute management such as agitation, aggressive behavior or disinhibition. Disclosure No significant relationships.

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Baar, J. Mark. "Organic Mood Disorder, Manic Type, Associated with Hyponatremia: A Case Report." International Journal of Psychiatry in Medicine 24, no. 3 (September 1994): 223–28. http://dx.doi.org/10.2190/bb2p-2ym7-69ge-wc7p.

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Objective: Mania and other mood changes are known to be associated with various organic etiologies. This article documents a case of organic mania associated with hyponatremia, a phenomenon which has not been previously reported, and reviews the pertinent medical literature. Method: The mental status of a patient with end stage renal disease and no previous psychiatric history who presented with mania and hyponatremia was carefully monitored while her serum sodium concentration was corrected. Results: The manic symptoms of the patient presented resolved completely with correction of serum sodium concentration alone. Conclusions: The acute episode of hyponatremia experienced by this patient with chronic, end stage renal disease appears to have precipitated the symptoms of mania. This observation may shed some additional light on the pathophysiology of organic mania.

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Novick, D., A. Gonzalez-Pinto, J. M. Haro, J. Bertsch, C. Reed, E. Perrin, and M. Tohen. "Translation of Randomised Controlled Trial Findings into Clinical Practice: Comparison of Olanzapine and Valproate in the Emblem Study." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70547-4.

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Aims:To contrast the outcomes of olanzapine- and valproate-treated patients in an observational study of acute mania with the results of a RCT assessing the same treatments (Tohen et al., 2002).Methods:EMBLEM (European Mania in Bipolar Evaluation of Medication) was a 2-year, prospective, observational study of health outcomes associated with treatment of mania. Severity of mania and depression was assessed at baseline and 6 weeks using the YMRS and 5-item version of the HAMD, respectively. The RCT was a 3-week, randomised, double-blind comparison of olanzapine (n=125) and divalproate-treated (n=123) patients hospitalised for acute manic or mixed episodes. The YMRS and HAMD were used to quantify manic and depressive symptoms, respectively.Results:621 EMBLEM patients were analysed (n=107 valproate, n=514 olanzapine). Both observed groups improved from baseline to 6 weeks in mean YMRS and HAMD-5 total scores, with significantly greater mean improvements in the olanzapine compared with the valproate group using linear regression to adjust for baseline differences. The RCT reported significantly greater mean YMRS improvement (but not HAMD) in the olanzapine-treated group. EMBLEM patients treated with olanzapine experienced significantly greater weight gain than patients treated with valproate, similar to RCT results. There was a significantly greater incidence of treatment-emergent gastrointestinal adverse events in EMBLEM patients treated with valproate.Conclusions:The EMBLEM results support those of the RCT, which suggest that olanzapine monotherapy may be more effective than valproate monotherapy in the treatment of acute mania. Contrasting observational and RCT results present methodological challenges but can provide important complementary information.

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Ketter, Terence A. "Reassessing Carbamazepine in Bipolar Disorders." CNS Spectrums 10, no. 6 (June 2005): 6–16. http://dx.doi.org/10.1017/s1092852900023087.

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This discussion focuses on the historical trends of carbamazepine in the treatment of acute mania, acute bipolar depression, and as maintenance treatment for bipolar disorder. Clinical implications of efficacy, safety, tolerability, and drug interactions associated with carbamazepine are discussed as well.Important progress in bipolar disorders therapeutics began in the 1970s with lithium and the conventional antipsychotics, and continued in the 1980s with carbamazepine, in the 1990s with divalproex, and in the 2000s with lamotrigine and the introduction of the atypical antipsychotics. Electroconvulsive therapy (ECT) has been used throughout these periods and still has a place in bipolar disorder, especially for severe, treatment-resistant, and very acute cases.Immediate-release carbamazepine was first approved for epilepsy in 1974, followed by approval of carbamazepine extended release capsules (CBZ ERC) for epilepsy in 1997. Reports of carbamazepine use in bipolar disorder began in 1973 in Japan, when Okuma and colleagues reported antimanic efficacy in manic-depressive psychosis. In 1978, Ballenger and Post reported effective use of carbamazepine in bipolar illness. The initiation of CBZ ERC in bipolar disorder trials began in 2001. In 2004, CBZ ERC received Food and Drug Administration approval for the treatment of acute manic and mixed episodes in patients with bipolar disorder (Slide 4).In 1988, a survey of American psychiatrists reported moderate-to-marked effectiveness for carbamazepine for the following conditions: partial complex seizures (85%), generalized seizures (82%), trigeminal neuralgia (81%), mania prophylaxis (72%), acute bipolar depression (67%), intermittent explosive disorder (65%), acute mania (62%), and schizoaffective disorder (58%). Historically, carbamazepine has been considered superior to lithium for rapid cycling and mixed mania, bipolar II disorder, bipolar disorder not otherwise specified (NOS), and bipolar disorder with mood incongruent delusions or comorbidity. In multiple controlled trials, carbamazepine was as effective as lithium in the treatment of acute mania. Limitations of early controlled carbamazepine trials include lack of parallel placebo groups, small samples (commonly <60 subjects), confounds of concomitant treatments, and low doses used to avoid/attenuate adverse effects.

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Andrade, F., A. S. Machado, A. Vieira, and A. Silva. "Bipolar mania with psychosis vs without psychosis: A clinical characterization with indirect measures of severity." European Psychiatry 64, S1 (April 2021): S82—S83. http://dx.doi.org/10.1192/j.eurpsy.2021.247.

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IntroductionThe presence of psychotic symptoms is highest during acute episodes of bipolar mania. There is no evidence base regarding the implications of psychosis in the prognosis of bipolar disorder, despite common assumption that their occurrence reflects greater disease severity.ObjectivesWe aim to compare sociodemographic and clinical characteristics of inpatients admitted for bipolar mania with and without psychotic features.MethodsRetrospective observational study of inpatients admitted between January 1st 2017 and 31 October 2020 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.ResultsBetween 2017 and October 2020 there were 103 admissions due to mania bipolar I disorder, 53.4% (n=55) with psychotic symptoms. When compared with mania without psychosis, psychotic mania was associated to male gender (71.1% to 39.7%; c2(1, N = 103) = 10,06; p = 0.02) and younger age (t(103) = -2.43; p = 0.017). The proportion of compulsory admissions and average length of stay were similar between mania with psychosis and mania without psychosis. Also, having a manic bipolar episode with psychotic symptoms was not associated to being prescribed a long-acting injectable antipsychotic.ConclusionsThe presence of psychotic symptoms in bipolar manic episodes were associated to male gender and younger age but not to indirect measures of illness severity.DisclosureNo significant relationships.

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Vasudev, Kamini, and Priya Sharma. "Is Valproate Depressogenic in Patients Remitting from Acute Mania? Case Series." Case Reports in Psychiatry 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/456830.

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Valproate is an effective antimanic agent and is recommended as a first-line medication in the treatment of acute mania. Current evidence based guidelines recommend that valproate should be given as a loading dose as it produces a rapid antimanic and antipsychotic response with minimal side-effects. However, no clear guidelines are available on the appropriate dosing or serum levels of valproate in the continuation or maintenance phase of bipolar disorder. We present 4 clinical cases to hypothesize that the higher doses of valproate, such as those used in the treatment of acute mania, may cause a depressive switch. So consideration should be given to reducing the dose of valproate if a patient develops depressive symptoms following recovery from the manic episode, as a therapeutic strategy. The cases also indicate that relatively lower doses and serum levels of valproate are effective in the maintenance phase compared to those needed in the acute manic phase of bipolar disorder. This is the first set of case series that questions the depressogenic potential of valproate in patients remitting from an acute manic episode. It highlights that different doses and serum levels of valproate may be therapeutic in different phases of bipolar disorder.

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Ambelas, A. "Life Events and Mania." British Journal of Psychiatry 150, no. 2 (February 1987): 235–40. http://dx.doi.org/10.1192/bjp.150.2.235.

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Fifty patients in their first manic episode were compared retrospectively with groups of (a) manic patients in other than first admissions and (b) acute surgical cases. They were then followed up for 3–8 years. First manic admissions were linked to life events far more frequently – 66%vs20% and 8% respectively for the other groups. Within-group comparisons showed patients with life events were much younger. The link between life events and manic episodes appeared immediate and selective, a view further supported by the findings of the follow-up. Later episodes precipitated by life events seem to require smaller amounts of stress. The possible role of life events in relation to mania is discussed.

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Glue, Paul, and Greg Tarr. "Comparative efficacy of anti-manic drugs in acute mania." Lancet 379, no. 9819 (March 2012): 892. http://dx.doi.org/10.1016/s0140-6736(12)60388-2.

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Dervaux, Alain, and Xavier Laqueille. "Comparative efficacy of anti-manic drugs in acute mania." Lancet 379, no. 9819 (March 2012): 892–93. http://dx.doi.org/10.1016/s0140-6736(12)60389-4.

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Grunze, Heinz, and Paula Fyans. "Comparative efficacy of anti-manic drugs in acute mania." Lancet 379, no. 9819 (March 2012): 893. http://dx.doi.org/10.1016/s0140-6736(12)60390-0.

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Fountoulakis, Konstantinos N., and Melina Siamouli. "Comparative efficacy of anti-manic drugs in acute mania." Lancet 379, no. 9819 (March 2012): 893–94. http://dx.doi.org/10.1016/s0140-6736(12)60391-2.

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Aissa, A., H. Ghabi, M. Ben Alaya, U. Ouali, S. Meddouri, and F. Nacef. "Impact of the COVID-19 pandemic and the lockdown period on the number of hospitalizations for acute mania." European Psychiatry 64, S1 (April 2021): S292. http://dx.doi.org/10.1192/j.eurpsy.2021.783.

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IntroductionCOVID-19 pandemic has affected social interaction and healthcare worldwide especially during the period of lockdown. As a result of this pandemic in Tunisia, the activity of hospital services and all non-emergency acts, in several specialties have been reduced. In psychiatry, such measures have not been taken. In the social zeitgeber hypothesis social rhythm disrupting life events such as eating, activity, and social patterns, may lead to the onset of manic episodes.ObjectivesThe objective of this study was to evaluate the impact of the COVID-19 pandemic on the frequency of acute mania in the context of bipolar disorder during the lockdown and post lockdown period compared to the same period during last year in a psychiatric department in Tunisia.MethodsWe assessed the number of hospitalizations in our department for acute mania in the context of bipolar disorder during the lockdown period in our country, (from March 1st and May 30, 2020) and during the two months following it. We compared this frequency to that of the previous year during the same periods.ResultsDuring the lockdown period, 17 patients were hospitalized for acute mania in the context of bipolar disorder. Sixty-seven patients were hospitalized in 2019 during the same period for acute mania. Nine hospitalizations for acute mania in the post lockdown period (between June and July 2020), were noted compared to 16 hospitalizations in the same period in 2019.ConclusionsLockdown seemed to have a protective effect from affective episodes in bipolar disorder. Perceiving increased connectedness among families may explain these findings.

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Post, Robert M., Philip G. Janicak, Melissa P. DelBello, and David L. Ginsberg. "Treatment of Bipolar Mania." CNS Spectrums 9, S1 (2004): 1–7. http://dx.doi.org/10.1017/s1092852900027139.

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AbstractWhile severity of manic episodes can be successfully reduced, repeated recurrences are common with ~40% of patients meeting criteria for rapid cycling after aggressive treatment. Manic episodes present much earlier in children of bipolars and due to unique presentation physicians often mistakenly diagnose such children with attention-deficit/hyperactivity disorder. Differential symptoms include suicidal thoughts, grandiosity, hallucinations, and depressive withdrawal. Such children may require the usual combination treatment with a mood stabilizer and an antipsychotic, with the addition of a stimulant as well. Treatment of adults and children often includes second-generation antipsychotics, which have increasingly shown efficacy both as monotherapy and adjunctive treatments of acute mania. Most recently, some anticonvulsants have demonstrated acute antimanic properties as well and more studies of their role in bipolar disorder are underway.

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Suárez Gómez, M., A. Suárez Gómez, P. Rodrigues, S. S. Sánchez Rus, and A. Matos-Pires. "Use of intravenous valproate in acute manic: about a clinical case." European Psychiatry 65, S1 (June 2022): S410—S411. http://dx.doi.org/10.1192/j.eurpsy.2022.1042.

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Introduction Acute mania can have behavioral effects such as agitation, being a frequent cause of presentation in the emergency department. Pharmacological treatments include mood stabilizers and atypical antipsychotics. Valproate is an effective drug. However, the intravenous formulation is relegated to other pathologies, such as epilepsy. Objectives The objective was to review the use of intravenous valproate in acute mania in the literature and present its use through a clinical case. Methods A clinical case using intravenous valproate to treat an episode of acute mania is described and the scientific literature of the last 5 years is reviewed. Results A 43-year-old patient attended the emergency department with a diagnosis of bipolar disorder type I in manic episode with agitation, rejection of oral medication, brought in by the police due to risk of aggression against family members, who reported that the patient had stopped taking her usual medication with valproate 500 mg / 24h and quetiapine 200 mg / 24h threemonths ago. Due to the possibility of having intravenous valproate, it was decided to administer 300 mg intravenously, as well as haloperidol 5 mg intravenously, and hospitalization was decided. The patient had a favorable evolution, with no side effects to the medication, and oral treatment was started after 8 hours, with a good response. In the literature there are few studies in this regard, although the most of them approved the use of valproate as a loading dose in acute mania. Conclusions Intravenous valproate is an effective, safe, and tolerated treatment in acute mania. More studies are needed to collect precise information. Disclosure No significant relationships.

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Schwartzmann, Ângela Maria, José Antonio Amaral, Cilly Issler, Sheila C. Caetano, Renata S. Tamada, Karla Mathias de Almeida, Marcia Brito de Macedo Soares, Rodrigo da Silva Dias, Cristiana C. Rocca, and Beny Lafer. "A clinical study comparing manic and mixed episodes in patients with bipolar disorder." Revista Brasileira de Psiquiatria 29, no. 2 (May 8, 2007): 130–33. http://dx.doi.org/10.1590/s1516-44462006005000036.

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OBJECTIVE: Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics. METHOD: Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores. RESULTS: Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared. Patients with mixed episodes were younger. CONCLUSION: In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies.

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Takeshima, Minoru. "Treating mixed mania/hypomania: a review and synthesis of the evidence." CNS Spectrums 22, no. 2 (December 22, 2016): 177–85. http://dx.doi.org/10.1017/s1092852916000845.

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The DSM–5 incorporates a broad concept of mixed states and captured ≥3 nonoverlapping symptoms of the opposite polarity using a “with mixed features” specifier to be applied to manic/hypomanic and major depressive episodes. Pharmacotherapy of mixed states is challenging because of the necessity to treat both manic/hypomanic and depressive symptoms concurrently. High-potency antipsychotics used to treat manic symptoms and antidepressants can potentially deteriorate symptoms of the opposite polarity. This review aimed to provide a synthesis of the current evidence for pharmacotherapy of mixed states with an emphasis on mixed mania/hypomania. A PubMed search was conducted for randomized controlled trials (RCTs) that were at least moderately sized, included a placebo arm, and contained information on acute-phase and maintenance treatments of adult patients with mixed episodes or mania/hypomania with significant depressive symptoms. Most studies were post-hoc subgroup and pooled analyses of the data from RCTs for acute manic and mixed episodes of bipolar I disorder; only two prospectively examined efficacy for mixed mania/hypomania specifically. Aripiprazole, asenapine, carbamazepine, olanzapine, and ziprasidone showed the strongest evidence of efficacy in acute-phase treatment. Quetiapine and divalproex/valproate were also efficacious. Combination therapies with these atypical antipsychotics and mood stabilizers can be considered in severe cases. Olanzapine and quetiapine (alone or in combination with lithium/divalproex) showed the strongest evidence of efficacy in maintenance treatment. Lithium and lamotrigine may be beneficial given their preventive effects on suicide and depressive relapse. Further prospective studies primarily focusing on mixed states are needed.

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Holtzheimer, Paul E., and John F. Neumaier. "Treatment of Acute Mania." CNS Spectrums 8, no. 12 (December 2003): 917–28. http://dx.doi.org/10.1017/s1092852900028698.

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AbstractMood stabilizers have evolved considerably over the past decade. Lithium, divalproex, and olanzapine are currently Food and Drug Administration-approved for the treatment of acute mania. A number of new and traditional medications have also been tested and are commonly used in clinical practice. Several strategies for managing treatment-resistant mania have been suggested, but few have been rigorously tested. Emphases on rapid stabilization and fewer side effects have raised the bar for what is expected from mood stabilizers and the successful treatment of mania involves a delicate balance between swiftness, short-term tolerability, and long-term safety.

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Dubey, Vaibhav. "Long-term effectiveness and safety of endoxifen in the treatment of bipolar mania: a case report." International Journal of Advances in Medicine 9, no. 2 (January 25, 2022): 169. http://dx.doi.org/10.18203/2349-3933.ijam20220042.

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Bipolar disorder (BD) displays abnormalities in protein kinase C (PKC) signaling, and evidence suggests that inhibiting PKC may help treat mania. Endoxifen a potent inhibitor of the PKC signaling pathway, is effective in controlling acute bipolar mania, at doses of 8 mg OD, for a period of 3-weeks. Here we present the case of a patient with severe mania, increased alcohol consumption administered endoxifen 8 mg BID for a period of 3-months, to achieve a better response. High-dose, long-term treatment with endoxifen was efficacious in controlling manic symptoms, with no adverse effects. Additionally, the patient didn’t consume alcohol during the course of treatment. This case showed the long-term effectiveness and safety of high-dose endoxifen to control mania in a patient with BD.

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DeJongh, Beth. "Lithium use in bipolar disorder: Summary of evidence for acute mania, acute depression, and maintenance treatment." Mental Health Clinician 2, no. 1 (July 1, 2012): 10–14. http://dx.doi.org/10.9740/mhc.n110748.

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Lithium has been used for more than 50 years for the treatment of bipolar disorder. There is a substantial body of literature about use of lithium in this condition, much of it with conflicting results. Many guidelines and algorithms support the use of lithium for treatment of episodes of acute mania and depression. However, additional research exploring prevention of depressive and manic relapse, treatment of acute depression, and use of combination treatments are needed.

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Ozcan, Halil, Tuba Ulkevan, Mehmet Fatih Ustundag, and Atakan Yucel. "Levetiracetam-Induced Acute Mania." Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology 25, no. 3 (September 2015): 319–20. http://dx.doi.org/10.5455/bcp.20150212042745.

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Gibson, A. C. "ECT for acute mania." British Journal of Psychiatry 187, no. 1 (July 2005): 91. http://dx.doi.org/10.1192/bjp.187.1.91-b.

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&NA;. "Clonazepam controls acute mania." Inpharma Weekly &NA;, no. 793 (June 1991): 10. http://dx.doi.org/10.2165/00128413-199107930-00022.

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Inzelberg, Rivka, Puiu Nisipeanu, Daphna Joel, Martha Sarkantyus, and Ralph L. Carasso. "Acute Mania and Hemichorea." Clinical Neuropharmacology 24, no. 5 (September 2001): 300–303. http://dx.doi.org/10.1097/00002826-200109000-00008.

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GUTTMACHER, LAURENCE, and JAN LEARD-HANSSON. "Risperidone and Acute Mania." Clinical Psychiatry News 35, no. 12 (December 2007): 15. http://dx.doi.org/10.1016/s0270-6644(07)70754-3.

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LEARD-HANSSON, JAN, and Laurence Guttmacher. "Oxcarbazepine for Acute Mania." Clinical Psychiatry News 36, no. 5 (May 2008): 10. http://dx.doi.org/10.1016/s0270-6644(08)70294-7.

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Gerner, Robert H. "Treatment of Acute Mania." Psychiatric Clinics of North America 16, no. 3 (September 1993): 443–60. http://dx.doi.org/10.1016/s0193-953x(18)30159-x.

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Alcorta, Diego, and Eduardo A. Balbo. "Dissertation on acute mania." History of Psychiatry 2, no. 6 (June 1991): 207–10. http://dx.doi.org/10.1177/0957154x9100200607.

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Alcorta, Diego. "Dissertation on acute mania." History of Psychiatry 2, no. 6 (June 1991): 211–17. http://dx.doi.org/10.1177/0957154x9100200608.

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GOLDBERG, JOSEPH F., and KATHERINE E. BURDICK. "Levetiracetam for Acute Mania." American Journal of Psychiatry 159, no. 1 (January 2002): 148. http://dx.doi.org/10.1176/appi.ajp.159.1.148.

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Pope, Harrison G. "Valproatereatment of Acute Mania." Archives of General Psychiatry 48, no. 1 (January 1, 1991): 62. http://dx.doi.org/10.1001/archpsyc.1991.01810250064008.

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Kubacki, Andrzej. "Male and Female Mania." Canadian Journal of Psychiatry 31, no. 1 (February 1986): 70–72. http://dx.doi.org/10.1177/070674378603100115.

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A total of 74 manic or hypomanic episodes were scrutinized in 31 probands (18 women and 13 men), followed over the years by the author on an outpatient basis. These turned out to herald bipolar affective illness in some 70 percent of males and almost 40% of females. Unipolar mania occurred twice as often in men, as it did in women (38,4% vs. 22,2%). Men tended to be younger (only 30% aged 45 or older), than women (almost a half in the menopausal age bracket). One third of all female probands (and over 46% of those under age 45) manifested their manic episodes in connection with childbirth (gestational mania). As a paradoxical, acute grief reaction (“funeral mania”), the syndrome under scrutiny, occurred in about 1/7 of the men, and more than 1/4 of the women. Significant medico-surgical problems were found to accompany or precede female mania twice as often, compared to male cases (61,1% vs. 30,7%); and clinical confusion or other indices of “organicity” were present in 2/3 of the women, and less than a half (46,1%) of the men. Over half the male probands demonstrated either an inverted sexual attraction, or hypogonadism; and four out of 13 males were aged 45 or older. The above findings are tentatively related to gender differential in cerebral hemispheric specialization.

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Carroll, Brendan T., Arthur Thalassinos, and Jay D. Fawver. "Loading Strategies in Acute Mania." CNS Spectrums 6, no. 11 (November 2001): 919–22. http://dx.doi.org/10.1017/s1092852900000985.

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AbstractTreatment of acute mania has been greatly influenced by loading strategies. Loading has potential benefits, including rapid symptom reduction in mania and a shortened length of stay. Disadvantages include an increased likelihood of adverse effects of the medications. Loading strategies for lithium, valproic acid (divalproex sodium), carbamazepine, oxcarbazepine, olanzapine, and haloperidol decanoate in the treatment of acute mania are discussed. Recent studies high-light this treatment option for selected patients. It is the unique properties of the medications that influence their use in loading. Issues in patient selection for loading strategies with each medication are also considered.

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Golebiowski, Raphael, Meghna Mansukhani, and Bhanu Prakash Kolla. "744 Correlates to improvement in sleep in acute mania." Sleep 44, Supplement_2 (May 1, 2021): A290. http://dx.doi.org/10.1093/sleep/zsab072.741.

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Abstract Introduction Sleep disruption and reduced sleep duration are potential triggers and also core symptoms of a manic episode. Our understanding of how sleep duration changes during the course of a manic episode and its potential association with symptom improvement is limited. We examined the natural course of sleep duration and its association with time to discharge and other clinical and demographic factors in patients with mania. Methods This was a retrospective study conducted in patients admitted to an acute care psychiatric unit with a manic episode. Sleep duration was determined based on observer report as logged by nursing staff. Sleep duration at admission and discharge were determined by averaging the total sleep time on day 2/3 of hospitalization and day 3/2 preceding discharge date. We obtained data on possible confounders including antipsychotic (chlorpromazine equivalents), benzodiazepine (diazepam equivalents) and other hypnotic medication doses administered at admission and discharge. We examined the associations between the change in sleep duration from admission to discharge with length of hospitalization and other clinical and demographic characteristics. Results The sample consisted of 35 patients (54.3% male) aged 32 ± 9.96 years with an average length of hospitalization of 20.63 ± 18.62 days. The mean sleep duration on admission was 6.23 ± 1.77 hours and was 7.45 ± 1.49 hours on discharge, with a mean change of 1.23 ± 1.93 hours. The change in sleep duration was positively correlated with length of hospitalization (r=0.42; p=0.01). Other clinical factors including benzodiazepine or antipsychotic dose on admission, age, sex, and use of mood stabilizers were not correlated with the change in sleep duration. Conclusion There was a substantial improvement in the total sleep duration in patients with mania over the course of hospitalization. Overall, the change in sleep duration was only correlated to the length of stay and did not appear to be impacted by other clinical and demographic characteristics. Support (if any):

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Vieta, Eduard, Michel Bourin, Raymond Sanchez, Ronald Marcus, Elyse Stock, Robert McQuade, William Carson, Neveen Abou-Gharbia, Rene Swanink, and Taro Iwamoto. "Effectiveness of aripiprazole v. Haloperidol in acute bipolar mania." British Journal of Psychiatry 187, no. 3 (September 2005): 235–42. http://dx.doi.org/10.1192/bjp.187.3.235.

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BackgroundDespite several treatment options, adherence to therapy is poor in patients with bipolar disorder.AimsA double-blind, controlled comparison of aripiprazole and haloperidol in patients with bipolar I disorder experiencing acute manic or mixed episodes.MethodPatients (n=347) were randomised to receive aripiprazole or haloperidol in this 12-week, multicentre study. The primary outcome measure was the number of patients in response (550% improvement from baseline in Young Mania Rating Scale score) and receiving therapy at week 12.ResultsAt week 12, significantly more patients taking aripiprazole (49. 7%) were in response and receiving therapy compared with those taking haloperidol (28. 4%; P<0. 001). Continuation rates differed markedly between treatments (week 12: aripiprazole, 50. 9%; haloperidol, 29. 1%). Extrapyramidal adverse events were more frequent with haloperidol than aripiprazole (62. 7% v. 24. 0%).ConclusionsAripiprazole showed superior levels of response and tolerability to haloperidol in the treatment of an acute manic episode for up to 12 weeks.

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Stahl, Stephen M., Sarah Laredo, and Debbi Ann Morrissette. "Cariprazine as a treatment across the bipolar I spectrum from depression to mania: mechanism of action and review of clinical data." Therapeutic Advances in Psychopharmacology 10 (January 2020): 204512532090575. http://dx.doi.org/10.1177/2045125320905752.

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Cariprazine is one of the newest dopamine-serotonin partial agonists, also known as ‘atypical’ second generation antipsychotics. Originally approved for acute and maintenance treatment of schizophrenia as well as for acute mania and mixed mania/depression, cariprazine has now been approved for bipolar I depression. Additionally, post hoc analyses of bipolar I depressed subjects show that both those with and those without concurrent manic features were improved following treatment with cariprazine. Maintenance studies are in progress in bipolar disorder, as are studies to augment antidepressants in unipolar major depressive episodes insufficiently responsive to treatment. Here, we review specifically the efficacy and safety data of cariprazine in bipolar I disorder and discuss the hypothesized mechanism of action of cariprazine and how it could theoretically be linked to caprazine’s broad therapeutic actions across the mood disorder spectrum.

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Applebaum, Julia, Joseph Levine, and R. H. Belmaker. "Intravenous Fosphenytoin in Acute Mania." Journal of Clinical Psychiatry 64, no. 4 (April 15, 2003): 408–9. http://dx.doi.org/10.4088/jcp.v64n0408.

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Journal articles on the topic 'Acute mania'

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