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1.07 - Approach to Bipolar Diathesis in Schizophrenia Spectrum Patients

from Part I - Treatment Strategies

Published online by Cambridge University Press:  19 October 2021

Edited by
Michael Cummings  and
Stephen Stahl
Michael Cummings
Affiliation:
University of California, Los Angeles
Stephen Stahl
Affiliation:
University of California, San Diego
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Summary

The mainstay of acute mania treatment for schizoaffective disorder, bipolar type (SAD-BT) patients includes the use of antipsychotic therapy combined with one of the two first-line mood stabilizers lithium or a form of valproic acid (VPA) (e.g. divalproex) [1, 2]. In controled acute mania studies with bipolar I patients, response rates to monotherapy with antipsychotics, lithium or VPA are comparable and roughly 50% [2]. While carbamazepine can be used for maintenance treatment, and has been studied in acute mania, rapid titration is poorly tolerated due to central nervous system (CNS) adverse effects such as sedation, dizziness, ataxia, and nausea, and thus should be avoided unless treatment with lithium or VPA is contraindicated [3]. As an inducer of cytochrome P450 (CYP) enzymes and the drug transporter P-glycoprotein (PGP), carbamazepine may reduce antipsychotic levels by 30–80% and thus presents a source of kinetic interaction than can be problematic during acute and maintenance treatment [4]. Carbamazepine is also associated with hyponatremia [1]. Other anticonvulsants have been studied for acute mania and have been found to be ineffective, including gabapentin, lamotrigine, licarbazepine, oxcarbazepine, and topiramate [2].

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Information
Management of Complex Treatment-resistant Psychotic Disorders , pp. 42 - 50
Publisher: Cambridge University Press
Print publication year: 2021

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