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Module 3Indications for Antipsychotics
Bipolar DisorderFlavio Guzmn, MD
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Outline
Indications of antipsychotics in differentphases of bipolar disorder: Mania/mixed states
Bipolar depression
Maintenance treatment
FDA approved agents for each phase
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Use of antipsychotics in bipolar diso
Bipolar depression
Mania Mixed states
Mainte
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Mania Management
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Acute mania pharmacother
Patients with BD spend much less time mania, hypomania, or mixed states tha
do in depression.
Many effective treatments for mania, fefor maintenance treatment or treatmen
bipolar depression.
Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of ClinicaPsychopharmacology. 7th ed.American Psychiatric Publishing
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Acute mania pharmacother
FGAs SGAs
Anticonvulsants Lithium
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Antipsychotics for mania
FGAs are effective in the treatment of mbut are frequently avoided due to the r
EPS.
Antipsychotics work as well as lithium iacute mania, even in the absence of
psychotic symptoms.
Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of ClinicaPsychopharmacology. 7th ed.American Psychiatric Publishing
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FGAs treatment
Patients with mood disorders might mo
vulnerable to developing TD than
schizophrenia patients.
Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of ClinicaPsychopharmacology. 7th ed.American Psychiatric Publishing
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Mixed Episodes
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FDA approved SGAs for
manic/mixed episodes
Manic/mixed ep
Aripiprazole
Asenapine
Quetiapine andquetiapine XR
Risperidone Olanzapine
Ziprasidone
Frye MA. Clinical practice. Bipolar disorder--a focus on depression
N Engl J Med. 2011;364(1):51-9.
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The role of SGAs in the treatment of manic/mixed e
Manic/mixed episodes
Aripiprazole
Asenapine
Quetiapine and quetiapine XR
Risperidone
Olanzapine
Ziprasidone
Manic/mixed episodes
Aripiprazole
Asenapine
Quetiapine and quetiapine XR
Risperidone
Olanzapine
Ziprasidone
LithiumD
Approved as
monotherapy
Approved as
adjunctive
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Bipolar Depression
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Bipolar depression
Depression is the predominant mood stbipolar disorder.
Some clinicians argue that this state is t
most difficult to treat. There are few proven strategies for bip
depression.
Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of ClinicaPsychopharmacology. 7th ed.American Psychiatric Publishing
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Bipolardepression
Quetiapine
Olanzapine/
fluoxetine
FDA approved SGAs forbipolar depression
Frye MA. Clinical practice. Bipolar disorder--a focus on depression
N Engl J Med. 2011;364(1):51-9.
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Maintenance treatment
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Maintenanctreatment
Aripiprazole
Olanzapine
Quetiapine anquetiapine XR
Risperidone (L
Ziprasidone
FDA approved SGAs for
maintenance
treatment
Frye MA. Clinical practice. Bipolar disorder--a focus on depression
N Engl J Med. 2011;364(1):51-9.
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Maintenance treatment: SG
Advantages
Titration is rapid andeasier. (Compared to
lamotrigine andlithium)
Safer in overdose
Disadvantage
Weight gain
Metabolic side
effects Sedation
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Take home points
Antipsychotics are effective for mania, mistates and bipolar depression.
Bipolar depress
Quetiapine
Olanzapine /fluoxetine
Manic/mixed episodesc
Aripiprazole
Asenapine
Quetiapine andquetiapine XR
Risperidone
Olanzapine
Ziprasidone
Maintenancetreatment
AripiprazoleOlanzapine
Quetiapine andquetiapine XR
Risperidone (LAI)
Ziprasidone
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References and further read
Frye MA. Clinical practice. Bipolardisorder--a focus on depression. N EnglMed. 2011;364(1):51-9.
Schatzberg, AF., Cole, JO, and DeBattist
C. Manual of ClinicalPsychopharmacology. 7th ed.AmericanPsychiatric Publishing, 2010.