Young Mania Rating Scale

Topiramate was also used as monotherapy in an open-label, collaborative, pilot study conducted by three groups of experienced investigators. Eleven acutely manic patients who were nonresponsive to lithium, VPA, or their combination continue to manifest significant symptoms with a mean baseline Young Mania Rating Scales (YMS) score of 32. Five of 11 patients had a substantial response (n = 3) or a partial response (n = 2) to the introduction of monotherapy with topiramate. 

In clinical practice in the treatment of bipolar disorder, many agents are used. Comparative or adjunctive efficacy are important considerations. In an open 12-week, randomized assignment study valproate was compared with lithium in 300 patients with acute mania [3 ]. Overall the two drugs reduced manic symptoms equally well, but valproate was superior to lithium in the number of subjects who achieved remission (72% versus 66%, defined as a Young Mania Rating Scale score of less than 12). Both drugs were associated with a 44% adverse effect rate. 

Antipsychotic drugs are more often used in the treatment of bipolar illness. Lithium was equivalent to aripiprazole, and both were superior to placebo, in a 3-week, double-blind, randomized, placebo-controlled study of acutely manic patients [5 ]. The improvement was maintained for an additional 9 weeks (a total of 12 weeks), with a 12.7 point drop in Young Mania Rating Scale score for lithium and a 14.5 point drop for aripiprazole. The most common adverse events with aripiprazole were headache, nausea, akathisia, sedation, and constipation and with lithium nausea, headache, constipation, and tremor. 

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