Page 12 - e-book CPG - Bipolar Disorder

CLINICAL PRACTICE GUIDELINES

± ECT**

Combination MS and AP:  carbamazepine  Add on: Haloperidol AP=antipsychotic AAP=atypical antipsychotic MS=mood stabiliser

MS: Lithium, valproate † , AP: Haloperidol, AAP ECT=electroconvulsive therapy

ALGORITHM 1. TREATMENT OF ACUTE MANIA ACUTE MANIA STEP 1* Monotherapy AP: Haloperidol OR No response in 2 weeks or intolerable AEs STEP 2 MS  OR  AAP  No response in 2 weeks or intolerable AEs STEP 3 Replace one or both agents with other agents in STEP 1

 OR AAP  Haloperidol viii

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

Psychosocial consider optimising patient’s preference
*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 risk of ECT previous good response to ECT
Intervention ± Psychotherapy treatment-resistant cases

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