Psychotic mania, has been better studied, and most, trial reports provide separate analysis for psychotic versus nonpsychotic patients. Finally, mixed mania has also been

studied in some trials, and may respond better to valproate, atypical antipsychotics – or a combination of the two – than to other traditional therapies,11 but still remains a. challenge, especially due to the high risk of switch to depression.12 Management of acute mania: first steps The goals of treatment of an acute manic or mixed episode are to alleviate Inhibitors,research,lifescience,medical symptoms and allow a return to usual levels of psychosocial functioning. Achieving rapid control of agitation, aggression, and impulsivity is

particularly important, to ensure the safety of patients and those around them, and to allow the establishment of a therapeutic alliance. Sometimes, compulsory hospitalization is needed to start effective treatment. Although diagnostic criteria allow Pexidartinib solubility dmso bipolar mood episodes to be defined as hypomanic, Inhibitors,research,lifescience,medical manic, or mixed, it can be difficult, Inhibitors,research,lifescience,medical to reliably discriminate between them. The degree or mood elevation per se is not the decisive factor in choosing among the three diagnoses; instead, the degree of impairment and behavioral disturbance, as evidenced by aggression, agitation, psychosis, poor judgment, and social or occupational dysfunction, is the usual precipitant of clinical attention and hence the primary target of Inhibitors,research,lifescience,medical intervention. In practical terms, therefore, bipolar I patients presenting

with a hypomanic, manic, or mixed episode can usually be managed with a common “acute mood elevation” strategy. However, even if the split between acute treatment and long-term Inhibitors,research,lifescience,medical treatment, makes sense from an operational perspective, in the last, few years it. has come clear that the best. approach to the treatment of bipolar disorder is an integrative management, approach, dealing with the urgent, and acute issues while keeping perspective on the longterm ones and functional outcome. For this reason, the treatment of mania must always take into account, the long-term issues, including not only the cross-sectional assessment but. also the predominant polarity of episodes,13 and the general principles SB-3CT as specified in the decalogue for the management of bipolar disorder,14 shown inTable I. Table I The decalogue of goals for intervention in bipolar disorder.14 Pharmacological treatment of acute mania The most widely used medications in the acute setting are lithium, some anticonvulsants (valproate, carbamazepine), standard antipsychotics (eg, haloperidol, chlorpromazine), atypical antipsychotics (eg, quetiapine, olanzapine, risperidone, ziprasidone, aripiprazole, clozapine), and benzodiazepines (eg, lorazepam, clonazepam).