rofessor Allan Young from theCentre for Mental Health atImperial Colle - PDF document

rofessor Allan Young from theCentre for Mental Health atImperial College, London dis-cussed the issue of continuationtherapy following an acute episodeshould last for 6-12 months aftersymptom remission; much longerthan might be thought.Episodes of mania are oftenmanaged by several treating teamsat different phases of the illness. Aclear overview of the individual’spattern of illness and continuity ofcare in the transition periodsbetween phases is increasinglyimportant. Goodwin and Jamisondefined the treatment phases ofresponse, ideally symptomaticongoing treat- Duration of mania episode is influenced by many fac-tors, especially medication. Thebackground risk of a switch topost-depression mania is 10-20 percent. A manic switch may occur insome cases through the use ofMania may beprecipitated by stopping lithiumabruptly:this may also be true ofated with an increased duration ofThe Royal College ofPsychiatry’s website states thatuntreated, a manic episode gen-erally last three to six months.However, there may be substan-tial inter-individual variation. Satellitesymposium 12th Latest Advances in Psychiatry Symposium 26 Progress in Neurology and Psychiatry May/June 2013www.progressnp.comCharacteristics and duration of mania:implications for continuation treatmentIn the continuation phase of treatment for acute mania, knowledge of the Wednesday 13th March 2013ProgressPsychopharmacology Special Interest Group of the Royal College of PsychiatristsLATEST ADVANCES INPSYCHIATRY PSYCHIATRY IN THE 21stCENTURY: FROM MOLECULE TO CLINIC Lundbecksatellite2013_Layout 1 05/06/2013 11:44 Page 1 12th Latest Advances in Psychiatry Symposium z Satellitesymposium Progress in Neurology and Psychiatry May/June 2013www.progressnp.com four (Q1) and eight to tenmonths (Q3).So what might have beenthought of as episode recurrenceepisode has been treated is likelyto be a relapse of the initialepisode. It is probably not a truerecurrence at all, rather a break-through of the initial episode.Therefore recurrence shouldonly be thought of as occurringafter the period of spontaneousnatural recovery – which couldeven be a year or more after theinitial episode, Professor Young treatment Understanding the naturalcourse of mania has significantimplications for continuationtreatment. Following an acutemanic episode, the duration ofthe hypothetical ‘untreated’ongoing vulnerability to episoderelapse, hence the recommenda-should be for 6-12 months afterData on the natural duration ofmixed episodes are rare. However,in treating mixed mania, it isimportant to consider thatepisodes of mixed or rapid cyclingmay well have a longer durationication that is effective in puremania may not be the treatmentof choice for a mixed episode. Forinstance, most efficacy data on thetreatment of mixed mania comesfrom the domised controlled trials. Thesebe so efficacious in mixed states asvalproate, risperidone or olanzap-Howe

ver, these data are notProfessor Young added that theuse of newer anti-manic agents intreatment is supported by trials oftrast, a continuation trial ofhaloperidol lasted only nineProfessor Young concluded byemphasising that the continua-tion phase of treatment covers aperiod of ongoing vulnerability tocommensurate with the estimatedduration of an untreated manicepisode. In mixed states, thisphase of vulnerability may beeven more prolonged. Currentfor 6-12 months after symptom References 1. Grunze H, Vieta E, Goodwin GM, World Federation of Societies of BiologicalPsychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders:update 2009 on the treatment of acute2. Goodwin FK, Jamison KR.Illness: Bipolar Disorder and Recurrent. 2nd edition. New York: OxfordUniversity Press, 2007. Part V: Treatment.Chapter 17: Fundamentals of treatment.‘Stages of treatment’, pp702-3.3. American Psychiatric Association. and Statistical Manual of Mental Disorders,4th edition (DSM-IV).Washington DC:4. Goldberg JF, Perlis RH, Bowden CL, Manic symptoms during depressive episodesin 1,380 patients with bipolar disorder: find-ings from the STEP-BD. 5. Salvadore G, Quiroz JA, Machado-Vieira R,in bipolar disorder: a review.6. Mander AJ, Loudon JB. The rapid recurrenceof mania following abrupt discontinuation of7. Strakowski SM, DelBello MP, Fleck DE, of bipolar disorder. 8. www.rcpsych.ac.uk/expertadvice/problems/bipolardisorder /bipolardisorder.aspx (accessed9. Angst J, Sellaro R. Historical perspectivesand natural history of bipolar disorder. 10. Wertham FI. A group of benign chronicpsychoses: prolonged manic excitements witha statistical study of age, duration and fre-quency in 2000 manic attacks. 11. Keller MB, Lavori PW, Coryell W, Differential outcome of pure manic,12. Angst J, Preisig M. Course of a clinicalcohort of unipolar, bipolar and schizoaffectivepatients. Results of a prospective study from1959 to 1985. 13. McIntyre RS, Cohen M, Zhao J, Asenapine for long-term treatment of bipolar disorder: a double-blind 40-weekextension study.14. Quiroz JA, Yatham LN, Palumbo JM, monotherapy in the maintenance treatmentof bipolar I disorder. 15. Smulevich AB, Khanna S, Eerdekens M, placebo-controlled trial followed by a 9-weekdouble-blind trial of risperidone and haloperi-  A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least one week (or any duration if hospitalisationis needed Three or more of the following symptoms are present to a significant- Increased self-esteem or grandiosity- Decreased need for sleep - More talkative than usual or pressure to keep talking- Flight of ideas or subjective experience that thoughts are racing - Increased goal-directed activity or psychomotor agitation- Excessive involvement in pleasurable activities with a high potential forTable 1. Lundbecksatellite2013_Layout 1 05/06/2013 11:44 Page 2