Li for sure (if tolerated). In general, any antipsychotic as an adjunct will do. For severe acute manias I prefer olanzapine IM 10 mg bid for the first 2-3 days, sometimes with lorazepam 2mg up to q6o if there is risk of self-harm and/or intense dysphoria. Maintenance... not olanzapine. I avoid aripiprazole due to occassional increase in dysphoria I have observed. I find it too "activating" at times.