Mania atypical antipsychotic dosing

TABLE 5-4. Summary of atypical antipsychotic dosing in acute mania... 

Risperidone (Risperdal). Risperidone is also approved by the FDA for the treatment of acute mania. It acts as an atypical antipsychotic at doses up to 4-6mg/day. Over this dose, and at lower doses in children and the elderly, risperidone acts more like a typical antipsychotic in that extrapyramidal side effects are common. 

Quetiapine (Seroquel). Another atypical antipsychotic, quetiapine has also been approved by the FDA for the treatment of acute mania. It is usually administered twice daily at doses of 150-750mg/day. Like its counterparts, quetiapine is a well-tolerated medication. Its common side effects are drowsiness, dizziness, and headache. It causes less weight gain than olanzapine or clozapine but more than ziprasidone or aripiprazole. Quetiapine also does not cause agranulocytosis nor does it increase the risk of seizures. It can occasionally cause mild changes in liver function tests, but these usually return to normal even if the patient continues taking quetiapine. 

FIGURE 7—35. Combination treatments for bipolar disorder (bipolar combos). Combination drug treatment is the rule rather than the exception for patients with bipolar disorder. It is best to attempt monotherapy, however, with first-line lithium or valproic acid, with second-line atypical antipsychotics, or with third-line anticonvulsant mood stabilizers. A very common situation in acute treatment of the manic phase of bipolar disorder is to treat with both a mood stabilizer and an atypical antipsychotic (atypical combo). Agitated patients may require intermittent doses of sedating benzodiazepines (benzo assault weapon), whereas patients out of control may require intermittent doses of tranquil-izing neuroleptics (neuroleptic nuclear weapon). For maintenance treatment, patients often require combinations of two mood stabilizers (mood stabilizer combo) or a mood stabilizer with an atypical antipsychotic (atypical combo). For patients who have depressive episodes despite mood stabilizer or atypical combos, antidepressants may be required (antidepressant combo). However, antidepressants may also decompensate patients into overt mania, rapid cycling states, or mixed states of mania and depression. Thus, antidepressant combos are used cautiously. 

Can be a more expensive atypical antipsychotic than some others when dosed appropriately in schizophrenia or acute mania some patients respond to moderate doses, which are less expensive... 

All anticonvulsants (except gabapentin), atypical antipsychotics, benzodiazepines, and calcium channel blockers require liver metabolism, and dosage adjustments may be needed (e.g., 25-50% reduction of normal doses) Carbamazepine or oxcarbazepine Alternative lamotrigine Acute mania or mixed episode first choice lithium... 

Drug treatment of childhood psychosis and other behavioral disorders of children is confused by diagnostic inconsistencies and a paucity of controlled trials. Antipsychotics can benefit children with disorders characterized by features that occur in adult psychoses, mania, autism, or Tourette s syndrome. Low doses of the more potent or modem atypical agents usually are preferred in an attempt to avoid interference with daytime activities or performance in school. Attention deficit disorder, with or without hyperactivity, responds poorly to antipsychotic agents, but... 

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