from Part I - Treatment Strategies
Published online by Cambridge University Press: 19 October 2021
The mainstay of acute mania treatment for schizoaffective disorder, bipolar type (SAD-BT) patients includes the use of antipsychotic therapy combined with one of the two first-line mood stabilizers lithium or a form of valproic acid (VPA) (e.g. divalproex) [1, 2]. In controled acute mania studies with bipolar I patients, response rates to monotherapy with antipsychotics, lithium or VPA are comparable and roughly 50% [2]. While carbamazepine can be used for maintenance treatment, and has been studied in acute mania, rapid titration is poorly tolerated due to central nervous system (CNS) adverse effects such as sedation, dizziness, ataxia, and nausea, and thus should be avoided unless treatment with lithium or VPA is contraindicated [3]. As an inducer of cytochrome P450 (CYP) enzymes and the drug transporter P-glycoprotein (PGP), carbamazepine may reduce antipsychotic levels by 30–80% and thus presents a source of kinetic interaction than can be problematic during acute and maintenance treatment [4]. Carbamazepine is also associated with hyponatremia [1]. Other anticonvulsants have been studied for acute mania and have been found to be ineffective, including gabapentin, lamotrigine, licarbazepine, oxcarbazepine, and topiramate [2].
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