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Psychiatric Times. Bipolar Disorder Quiz
October 20, 2010
Which medications have typically been used as first-line treatment for acute mania? Is comorbidity the rule or the exception in patients with bipolar disorder? These questions and more in this week's quiz.
by James Phelps | November 13, 2010 6:17 PM EST Thanks to Drs. Sherak and Hardy for their comments above, which are important and well stated. Add the cost to patients for aripiprazole: in my area the co-pay is close to $100/month on average, far far above the cost for them of the numerous alternatives. One could almost wonder if somehow this question was framed by the manufacturer of aripiprazole, as it should be far from "routine" to be using their drug for this purpose. Keep your ears on. Jim Phelps, M.D. by Donald Sherak | November 11, 2010 1:39 PM EST I think it is wrong to label this combination treatment as being used "tratditionaly". Some, such as N. Ghami suggest that the use of a med with a good, very long track record that has demonstrated efficacy for maintenance (lithium) work well in initial treatment when paired with a med shown effective in acute treatment, such as a second generation antipsychotic. It still might be a bit early to accept that the SGAs are as effective in maintenance phase. More long term data is needed. by Marcos Hardy | November 11, 2010 1:32 PM EST 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. |
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