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Feature Article

Bipolar disorder: focus on mania

Philip B Mitchell, Jillian R Ball, Bronwyn Gould

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Abstract

An episode of acute mania is a medical emergency. The GP can play a pivotal role in its early identification and prevention, and may need to initiate treatment if there are limited local mental health services.

Key Points

  • An episode of acute mania is a medical emergency. Insight and judgement are usually impaired early and urgent involuntary hospitalisation under the relevant mental health legislation is frequently required to protect the patient.
  • GPs have an important role in early identification and prevention of mania, and may need to initiate treatment if there are limited local mental health services.
  • The two components of the pharmacological management of acute mania are primary treatment of the pathologically elevated mood and short-term containment of any associated behavioural disturbance such as aggression or violence, agitation or overactivity, and disinhibition.
  • Primary treatment of the pathologically elevated mood is with lithium, sodium valproate, carbamazepine or a second-generation antipsychotic. This treatment will usually be continued for prophylaxis.
  • Short-term containment of associated behavioural disturbance comprises calming or sedating the patient until their mood stabilises, and usually involves temporary use of supplementary antipsychotics or benzodiazepines.
  • Psychological therapies have a critical role in preventing relapse into mania and stopping mild elevations of mood progressing to full manic presentations.

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