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    FDA approved agents for each phase Use of antipsychotics in bipolar disorder. Patients with BD spend much less time in mania, hypomania, or mixed states than they do in depression. There are few proven strategies for bipolar depression.

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    FDA approved agents for each phase Use of antipsychotics in bipolar disorder. Patients with BD spend much less time in mania, hypomania, or mixed states than they do in depression. There are few proven strategies for bipolar depression.

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    Attribution Non-Commercial (BY-NC)
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    257 views19 pages

    Module 3 - D - Antipsychotics For Bipolar Disorder

    Uploaded by

    psychopharmacology
    FDA approved agents for each phase Use of antipsychotics in bipolar disorder. Patients with BD spend much less time in mania, hypomania, or mixed states than they do in depression. There are few proven strategies for bipolar depression.

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    Attribution Non-Commercial (BY-NC)
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    Module 3 Indications for Antipsychotics Bipolar Disorder

    Flavio Guzmn, MD

    Outline
    Indications of antipsychotics in different phases of bipolar disorder:
    Mania/mixed states Bipolar depression Maintenance treatment

    FDA approved agents for each phase

    Use of antipsychotics in bipolar disorder


    Mania

    Mixed states

    Maintenance

    Bipolar depression

    Mania Management

    Acute mania pharmacotherapy


    Patients with BD spend much less time in mania, hypomania, or mixed states than they do in depression. Many effective treatments for mania, fewer for maintenance treatment or treatment of bipolar depression.
    Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of Clinical Psychopharmacology. 7th ed.American Psychiatric Publishing, 2010.

    Acute mania pharmacotherapy


    FGAs SGAs

    Anticonvulsants

    Lithium

    Antipsychotics for mania


    FGAs are effective in the treatment of mania, but are frequently avoided due to the risk of EPS. Antipsychotics work as well as lithium in acute mania, even in the absence of psychotic symptoms.
    Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of Clinical Psychopharmacology. 7th ed.American Psychiatric Publishing, 2010.

    FGAs treatment
    Patients with mood disorders might more vulnerable to developing TD than schizophrenia patients.

    Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of Clinical Psychopharmacology. 7th ed.American Psychiatric Publishing, 2010.

    Mixed Episodes

    FDA approved SGAs for manic/mixed episodes

    Manic/mixed episodes Aripiprazole Asenapine Quetiapine and quetiapine XR Risperidone Olanzapine Ziprasidone

    Frye MA. Clinical practice. Bipolar disorder--a focus on depression. N Engl J Med. 2011;364(1):51-9.

    The role of SGAs in the treatment of manic/mixed episodes


    Manic/mixed episodes

    Approved as

    monotherapy

    Aripiprazole Asenapine Quetiapine and quetiapine XR Risperidone Olanzapine Ziprasidone

    Manic/mixed episodes

    Approved as

    adjunctive

    Aripiprazole Asenapine Quetiapine and quetiapine XR Risperidone Olanzapine Ziprasidone

    Lithium

    Divalproex sodium

    Bipolar Depression

    Bipolar depression
    Depression is the predominant mood state in bipolar disorder. Some clinicians argue that this state is the most difficult to treat. There are few proven strategies for bipolar depression.
    Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of Clinical Psychopharmacology. 7th ed.American Psychiatric Publishing, 2010.

    FDA approved SGAs for bipolar depression

    Bipolar depression
    Quetiapine Olanzapine/ fluoxetine

    Frye MA. Clinical practice. Bipolar disorder--a focus on depression. N Engl J Med. 2011;364(1):51-9.

    Maintenance treatment

    FDA approved SGAs for maintenance treatment

    Maintenance treatment Aripiprazole Olanzapine Quetiapine and quetiapine XR Risperidone (LAI) Ziprasidone

    Frye MA. Clinical practice. Bipolar disorder--a focus on depression. N Engl J Med. 2011;364(1):51-9.

    Maintenance treatment: SGAs


    Advantages Titration is rapid and easier. (Compared to lamotrigine and lithium) Safer in overdose Disadvantages Weight gain Metabolic side effects Sedation

    Take home points


    Antipsychotics are effective for mania, mixed states and bipolar depression.
    Manic/mixed episodesc Aripiprazole Asenapine Quetiapine and quetiapine XR Risperidone Olanzapine Ziprasidone

    Maintenance treatment Aripiprazole Olanzapine Quetiapine and quetiapine XR Risperidone (LAI) Ziprasidone Bipolar depression Quetiapine Olanzapine / fluoxetine

    References and further reading


    Frye MA. Clinical practice. Bipolar disorder--a focus on depression. N Engl J Med. 2011;364(1):51-9. Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of Clinical Psychopharmacology. 7th ed.American Psychiatric Publishing, 2010.

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