Page 4 - e-book QR - BIPOLAR DISORDER 2ND ED

QUICK REFERENCE MANAGEMENT OF BIPOLAR DISORDER (2ND EDITION)

± ECT**
± ECT**/rTMS

Combination MS & AP: MS: Lithium, valproate † ,  carbamazepine AP: Haloperidol, AAP  Add on: Haloperidol AP = antipsychotic AAP = atypical antipsychotic ECT = electroconvulsive therapy MS = mood stabiliser Combi

ALGORITHM 1. TREATMENT OF ACUTE MANIA Haloperidol OR  AAP  MS  1 Lumateperone No response in 2 weeks or intolerable AEs MS + AAP  MS + MS   No response in 2 weeks or intolerable AEs

ACUTE MANIA STEP 1* Monotherapy AP:  OR AAP  No response in 2 weeks or intolerable AEs STEP 2 OR Haloperidol No response in 2 weeks or intolerable AEs STEP 3 Replace one or both agents wi

Monotherapy MS: Lithium  Valproate †  Carbamazepine  Switch: MS   AAP  † Valproate - Safety concerns present, refer to Appendix 5 and 9 in CPG Monotherapy MS: Lamotrigine  Valproate †  Lithium 

*If the patient is already on treatment: antidepressants should be discontinued **ECT should be considered in the following conditions: rapid definitive response is required risk of other alternatives outweighs
Intervention ± Psychotherapy
Psychosocial consider optimising patient’s preference treatment-resistant cases rapid definitive response is required previous good response to ECT
Psychosocial Intervention ± Psychotherapy patient’s preference treatment-resistant cases
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