SS03.03 - From study to practice in bipolar mania: Recommendations for optimizing the clinical benefits of new antipsychotics

Abstract

The safety and efficacy of newer atypical antipsychotics have been demonstrated in recent short- and longer-term studies in patients with bipolar mania. Overall, three key principles for the use of newer atypical antipsychotics in bipolar mania are (1) consider the pharmacological profile of previous medications, (2) switch gradually – avoid abrupt discontinuation of previous medications, and (3) expect a different response with less-sedating antipsychotics. This presentation will provide practical guidance on the use of such agents in bipolar mania. Choosing the right starting dose, titration schedule and adjunctive medications are the key to successful treatment; and it should be remembered that a single dose or treatment algorithm is unlikely to be effective for all patients. Dose adjustments based on response and tolerability can be made, if necessary, in order to maximise treatment outcomes. In situations where additional symptoms or initial side effects are present, adjunctive medications may be useful, including benzodiazepines, anticholinergics, propranolol, antihistamines, and sedatives/hypnotics. Ultimately, the goal is to treat the patient as effectively as possible in the acute period with minimal side effects and achieve a smooth transition to long-term maintenance treatment. Switching to a newer atypical antipsychotic may be of benefit to patients experiencing inadequate efficacy or intolerable side effects with their current medication.