Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-27T14:26:45.621Z Has data issue: false hasContentIssue false

Chapter 20 - An Update on the Treatment of Manic and Hypomanic States

Published online by Cambridge University Press:  16 May 2024

By
Sameer Jauhar  and
Sui Liem Alexandre Wong
Edited by
Allan Young ,
Marsal Sanches ,
Jair C. Soares  and
Mario Juruena
Allan Young
Affiliation:
Institute of Psychiatry, King's College London
Marsal Sanches
Affiliation:
Baylor College of Medicine, Texas
Jair C. Soares
Affiliation:
McGovern Medical School, The University of Texas
Mario Juruena
Affiliation:
King's College London
Get access

Summary

Acute mania is a medical emergency and requires assiduous treatment to prevent significant risks to the individual, as well as effects on aspects of their psychosocial functioning. Hypomania has a similar clinical profile, with the absence of psychotic symptoms and disruption of functioning being the main factors differentiating it from mania. In this chapter we cover the key points in regard to clinical signs and management of mania and hypomania, predominantly focusing on pharmacological treatments. A number of national and international guidelines have covered this in depth, and we summarise their findings in this chapter. First-, second-, and third-line medication options for the acute phases are reviewed, while we also discuss combination strategies to address specific symptoms (e.g., agitation) and maintenance treatments aiming at relapse prevention and functional recovery.

Keywords

maniahypomaniabipolar disorderpsychopharmacologyacute treatmentmaintenance
Type
Chapter
Information
Clinical Textbook of Mood Disorders , pp. 206 - 212
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

McIntyre, RS, Berk, M, Brietzke, E, et al. Bipolar disorders. Lancet 2020;396:1841–56.CrossRefGoogle ScholarPubMed
International Classification of Diseases 11th Revision. Geneva: World Health Organization, 2019. https://icd.who.int/en (accessed May 8, 2022).Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Association, 2013.Google Scholar
Merikangas, KR, Jin, R, He, J-P, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011;68:241–51.CrossRefGoogle ScholarPubMed
Bessonova, L, Ogden, K, Doane, MJ, O’Sullivan, AK, Tohen, M. the economic burden of bipolar disorder in the United States: a systematic literature review. Clinicoecon Outcomes Res 2020;12:481–97.CrossRefGoogle ScholarPubMed
Cloutier, M, Greene, M, Guerin, A, Touya, M, Wu, E. The economic burden of bipolar I disorder in the United States in 2015. J Affect Disord 2018;226: 45–51.CrossRefGoogle ScholarPubMed
Kessing, LV, Vradi, E, Andersen, PK. Life expectancy in bipolar disorder. Bipolar Disord 2015;17:543–8.CrossRefGoogle ScholarPubMed
Jauhar, S, Krishnadas, R, Nour, MM, et al. Is there a symptomatic distinction between the affective psychoses and schizophrenia? A machine learning approach. Schizophr Res 2018;202:241–7.CrossRefGoogle Scholar
García, S, Martínez-Cengotitabengoa, M, López-Zurbano, S, et al. Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients. J Clin Psychopharmacol 2016;36:355–71.CrossRefGoogle ScholarPubMed
Jauhar, S, Nour, MM, Veronese, M, et al. A test of the transdiagnostic dopamine hypothesis of psychosis using positron emission tomographic imaging in bipolar affective disorder and schizophrenia. JAMA Psychiatry 2017;74:1206–13.CrossRefGoogle Scholar
Yildiz, A, Vieta, E, Leucht, S, Baldessarini, RJ. Efficacy of antimanic treatments: meta-analysis of randomized, controlled trials. Neuropsychopharmacology 2011;36: 375–89.CrossRefGoogle ScholarPubMed
Yildiz, A, Nikodem, M, Vieta, E, Correll, CU, Baldessarini, RJ. A network meta-analysis on comparative efficacy and all-cause discontinuation of antimanic treatments in acute bipolar mania. Psychol Med 2015;45:299–317.CrossRefGoogle ScholarPubMed
Fountoulakis, KN, Grunze, H, Vieta, E, et al. The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), part 3: the clinical guidelines. Int J Neuropsychopharmacol 2016;20:180–95.Google Scholar
Yatham, LN, Kennedy, SH, Parikh, SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018;20:97–170.CrossRefGoogle Scholar
Cipriani, A, Barbui, C, Salanti, G, et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. Lancet 2011;378:1306–15.CrossRefGoogle Scholar
Goodwin, GM, Haddad, PM, Ferrier, IN, et al. Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol (Oxford) 2016;30:495–553.CrossRefGoogle ScholarPubMed
Geddes, JR, Miklowitz, DJ. Treatment of bipolar disorder. Lancet 2013;381:1672–82.CrossRefGoogle ScholarPubMed
Malhi, GS, Bassett, D, Boyce, P, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015;49:1087–206.CrossRefGoogle ScholarPubMed
Morriss, R. Mandatory implementation of NICE Guidelines for the care of bipolar disorder and other conditions in England and Wales. BMC Medicine 2015;13:246.CrossRefGoogle ScholarPubMed
Taylor, DM, Barnes, TRE, Young, AH. The Maudsley Prescribing Guidelines in Psychiatry. 13th ed. New York: Wiley-Blackwell, 2018.Google Scholar
Pacchiarotti, I, Anmella, G, Colomer, L, Vieta, E. How to treat mania. Acta Psychiatr Scand 2020;142(3):173–92.CrossRefGoogle ScholarPubMed
Stahl, SM, Laredo, S, Morrissette, DA. Cariprazine as a treatment across the bipolar I spectrum from depression to mania: mechanism of action and review of clinical data. Ther Adv Psychopharmacol 2020;10. doi:10.1177/2045125320905752.CrossRefGoogle ScholarPubMed
Pinto, JV, Saraf, G, Vigo, D et al. Cariprazine in the treatment of bipolar disorder: a systematic review and meta-analysis. Bipolar Disord 2020;22:360–71.CrossRefGoogle ScholarPubMed
Vieta, E, Durgam, S, Lu, K et al. Effect of cariprazine across the symptoms of mania in bipolar I disorder: analyses of pooled data from phase II/III trials. Eur Neuropsychopharmacol 2015;25:1882–91.CrossRefGoogle ScholarPubMed
Ogawa, Y, Tajika, A, Takeshima, N, Hayasaka, Y, Furukawa, TA. Mood stabilizers and antipsychotics for acute mania: a systematic review and meta-analysis of combination/augmentation therapy versus monotherapy. CNS Drugs 2014;28:989–1003.CrossRefGoogle Scholar
Glue, P, Herbison, P. Comparative efficacy and acceptability of combined antipsychotics and mood stabilizers versus individual drug classes for acute mania: network meta-analysis. Aust N Z J Psychiatry 2015;49:1215–20.CrossRefGoogle ScholarPubMed
Vieta, E, Ramey, T, Keller, D et al. in the treatment of acute mania: a 12-week, placebo-controlled, haloperidol-referenced study. J Psychopharmacol 2010;24:547–58.CrossRefGoogle Scholar
Elias, A, Thomas, N, Sackeim, HA. Electroconvulsive therapy in mania: a review of 80 years of clinical experience. Am J Psychiatry 2021;178:229–39.CrossRefGoogle Scholar
Yildiz, A, Guleryuz, S, Ankerst, DP, Ongür, D, Renshaw, PF. Protein kinase C inhibition in the treatment of mania: a double-blind, placebo-controlled trial of tamoxifen. Arch Gen Psychiatry 2008;65:255–63.CrossRefGoogle Scholar
Weiser, M, Burshtein, S, Gershon, AA, et al. Allopurinol for mania: a randomized trial of allopurinol versus placebo as add-on treatment to mood stabilizers and/or antipsychotic agents in manic patients with bipolar disorder. Bipolar Disord 2014;16:441–7.CrossRefGoogle ScholarPubMed
Rosa, AR, Fountoulakis, K, Siamouli, M, Gonda, X, Vieta, E. Is anticonvulsant treatment of mania a class effect? Data from randomized clinical trials. CNS Neurosci Ther 2011;17:167–77.CrossRefGoogle Scholar
Veronese, N, Solmi, M, Luchini, C, et al. Acetylcholinesterase inhibitors and memantine in bipolar disorder: a systematic review and best evidence synthesis of the efficacy and safety for multiple disease dimensions. J Affect Disord 2016; 197:268–80.CrossRefGoogle ScholarPubMed
Fountoulakis, KN, Yatham, LN, Grunze, H, et al. The CINP guidelines on the definition and evidence-based interventions for treatment-resistant bipolar disorder. Int J Neuropsychopharmacol 2020;23: 230–56.CrossRefGoogle ScholarPubMed
Baldessarini, RJ, Tondo, L, Vázquez, GH. Pharmacological treatment of adult bipolar disorder. Mol Psychiatry 2019;24:198–217.CrossRefGoogle ScholarPubMed
Kessing, LV, Søndergård, L, Kvist, K, Andersen, PK. Adherence to lithium in naturalistic settings: results from a nationwide pharmacoepidemiological study. Bipolar Disord 2007;9:730–6.CrossRefGoogle ScholarPubMed
Severus, E, Taylor, MJ, Sauer, C, et al. Lithium for prevention of mood episodes in bipolar disorders: systematic review and meta-analysis. Int J Bipolar Disord 2014;2:15.CrossRefGoogle ScholarPubMed
Winstanley, J, Young, AH, Jauhar, S. Back to basics – a UK perspective on ‘Make lithium great again’ Malhi et al. Bipolar Disord 2021;23:97–8.CrossRefGoogle Scholar
Lindström, L, Lindström, E, Nilsson, M, Höistad, M. Maintenance therapy with second generation antipsychotics for bipolar disorder – a systematic review and meta-analysis. J Affect Disord 2017;213: 138–50.CrossRefGoogle ScholarPubMed
Jauhar, S, Young, AH. Controversies in bipolar disorder; role of second-generation antipsychotic for maintenance therapy. Int J Bipolar Disord 2019;7:10.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×