OBJECTIVES To summarize the quality of evidence for the efficacy of different biological treatments in mania, mixed state, and rapid cycling and to propose guidelines for treatment of these conditions. METHOD Articles published on treatment of acute mania, mixed states, and rapid cycling were reviewed and rated for quality of evidence using Periodic Health Examination guidelines. RESULTS Li...

Cariprazine is a recently developed antipsychotic drug with a partial agonism for the D2 and D3 receptors. It shows a tenfold greater affinity for the D3 receptor. In clinical trials, its therapeutic effect has been tested in patients with an acute exacerbation of schizophrenia and in patients with acute mania in bipolar disorder. Like risperidone, cariprazine improves positive and negative sch...

Objectives This is a protocol for Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of electroconvulsive therapy an acute affective episode (hypomania, mania, mixed state or depression) in children, adolescents, adults older people with bipolar disorder.

Results and conclusions For treatment of acute mania lithium, valproate and carbamazepine are more effective than placebo but they have no superiority over antipsychotics. There is evidence from RCTs that second generation antipsychotics (SGA) are more effective than placebo. Haloperidol may be more effective than SGA in treatment of acute mania. Combination of antipsychotic and mood stabiliser...

OBJECTIVE The authors compared the efficacy and safety of aripiprazole, a novel antipsychotic, to placebo for treatment of patients in an acute manic or mixed episode of bipolar disorder. METHOD This 3-week, multicenter, double-blind study randomly assigned 262 bipolar disorder patients in an acute manic or mixed episode to aripiprazole, 30 mg/day (reduced to 15 mg/day if needed for tolerabil...

BACKGROUND The major diagnostic classifications consider mania as a uni-dimensional illness. Factor analytic studies of acute mania are fewer compared to schizophrenia and depression. Evidence from factor analysis suggests more categories or subtypes than what is included in the classification systems. Studies have found that these factors can predict differences in treatment response and progn...

BACKGROUND Little is known about the cause and psychopathology of delirious mania, a type of disorder where delirium and mania occur at the same time. This condition still has no formal diagnostic classification. To provide more information about this potentially life-threatening condition, we studied five patients with delirious mania. METHODS We describe the cases of five patients with deli...

BACKGROUND During post-acute phase pharmacotherapy for bipolar disorder, there has been little empirical study to establish when emerging mania symptoms (1) are of clinical significance and (2) reflect iatrogenic events versus the natural course of illness. METHOD Secondary analyses were conducted in a previously studied group of bipolar I disorder (DSM-IV) outpatients randomly assigned to la...