Atypical medications bipolar disorders

Anticonvulsdnts. An early observation that BN patients may have abnormal electroencephalogram (EEG) resnlts led to specnlation that binge eating may represent an atypical behavioral presentation of seiznre activity. Thus, the first controlled medication study for the treatment of BN evaluated the use of the antiseizure medication phenytoin (Dilantin). Phenytoin was not found to be significantly superior to placebo, and the earlier reports of EEG abnormalities were not confirmed. The results of a subsequent trial of carbamazepine (Tegretol), an anticonvulsant that has been reported to be effective in the treatment of bipolar disorder, were also disappointing. As a result, anticonvulsants are not routinely used in the treatment of BN. 

When these measures have failed and impulsivity and aggression remain a problem, additional strategies are available. First, reconsider the diagnosis. Does the patient have bipolar disorder rather than ADHD Is there another disruptive behavior disorder in addition to or instead of ADHD Does (s)he have an impulse control disorder In these more severe cases, other medications such as atypical antipsychot-ics or mood stabilizers are often helpful. 

Lithium, several (but not all) anticonvulsants, and most of the atypical antipsychotic medications are approved by the U.S. Food and Drug Administration (FDA) for the treatment of one of more phases of bipolar disorder. These medications are referred to as mood stabilizers, and they are the foundation of treatment for bipolar disorders. However, the skillful treatment of bipolar disorder requires not only the knowledge of how to prescribe one or more of these medications but also the understanding that some medications are preferred for one phase of the illness but not the other or for long-term use but not necessarily acute use. In this chapter, we first review the clinical use of lithium and the anticonvulsants that are definite or probable mood stabilizers. The general properties of atypical anti-psychotics are reviewed in Chapter 4. In this chapter, we expand on the use of these compounds for the treatment of bipolar disorder. Discussion of the treatment of each phase of bipolar disorder concludes the chapter. 

The atypical neuroleptics—or new generation neuroleptics—cause fewer adverse side effects, are more effective in managing the symptoms of schizophrenia, and are effective for the treatment of bipolar disorder with or without psychosis. However, these drugs are cost more than the older medications. The five approved in the United States as of 2002 are ... 

In terms of approved medical use, the neuroleptics are often prescribed for children with autism, attention-deficit hyperactivity disorder (ADHD), and Tourette s syndrome. In addition, the popularity of the newer atypical neuroleptics for childhood bipolar disorder is growing rapidly, and sometimes these drugs are the only treatment offered. The neuroleptics are also commonly prescribed for the elderly in nursing homes or other insti-... 

Usually administered as adjunctive medication to other anticonvulsants, lithium, or atypical anti psych otics for bipolar disorder... 

The medications known as anticonvulsants are often used as front-line treatment of the bipolar disorders. The most common of these medications include Tegretol (carbamazepine), Depakene or Depakote (valproate or valproic acid), and Klonopin (clonazepam), and they are used under the following circumstances (a) inadequate response or intolerance to antipsy-chotics or lithium (b) manic symptoms (c) rapid cycling of the condition (d) EEG abnormalities and (e) head trauma (Kaplan Sadock, 1996). In practice, these medications seem particularly effective for clients who suffer from schizoaffective disorders or agitated depression of a cyclic nature. They are considered the medication of choice if an individual has a history of brain damage or of severe or rapid mood swings (Dulcan, 1999). Furthermore, if an individual has atypical features of the mental... 

Psychiatrists prescribe antipsychotics to treat mental illnesses that cause patients to experience marked breaks with reality (psychosis). The most common of such disorders is schizophrenia, which is a chronic, disabling, persistent, and severe brain disease that sigpiificantly impairs brain functioning and affects 1 percent of the world s population, including 3 million people in the United States alone. Antipsychotic medications are referred to as typical or atypical. Psychiatrists prescribe anxiolytics (antianxiety medications) to treat anxiety disorders, which include panic disorder, generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, social anxiety disorder, and posttraumatic stress disorder. Psychiatrists prescribe antidepressants and mood stabilizers to treat the symptoms of mood disorders, the most common and severe of which are major depression and bipolar disorder. 

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