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Specific antipsychotics Bipolar disorder CHAPTER 2 Bipolar depression In acute treatment of bipolar depression, antipsychotics found to be effective include cariprazine, lumateperone, lurasidone, olanzapine (± fluoxetine) and quetiapine.14,19,20 In terms of me...

References Bipolar disorder CHAPTER 2 References ECNP. Neuroscience-­based nomenclature (NbN). 2024; https://www.ecnp.eu/research-­innovation/nomenclature. Cipriani A, et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple...

Antipsychotic long-acting injections in bipolar disorder Bipolar disorder CHAPTER 2 Antipsychotic long-­acting injections in bipolar disorder LAIs are widely used in bipolar disorder although none is formally licensed in the UK for this indication (Abilify Mai...

Conclusion 306 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 neither decreases nor increases the risk of depressive relapse. Risperidone LAI may be less effective than oral olanzapine. It might be assumed that paliperidone LAI has similar effect...

References Bipolar disorder CHAPTER 2 References Keramatian K, et al. Long-­acting injectable second-­generation/atypical antipsychotics for the management of bipolar disorder: a systematic review. CNS Drugs 2019; 33:431–­456. Pacchiarotti I, et al. Long-­act...

Physical monitoring for people with bipolar disorder1,2 Physical monitoring for people with bipolar disorder1,2 Monitoring for all patients Additional monitoring for specific drugs Test or measurement Initial health check Annual check-up Antipsychotics Lithium...

References Prolactin Children and adolescents only At start and if symptoms of raised prolactin develop   Raised prolactin unlikely with quetiapine or aripiprazole. Very occasionally seen with olanzapine and asenapine. Very common with risperidone and FGAs. EC...

Treatment of acute mania or hypomania 310 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 Treatment of acute mania or hypomania Drug treatment is the mainstay of therapy for mania and hypomania. Both antipsychotics and mood stabilisers are effecti...

References 312 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 References Cipriani A, et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-­treatments meta-­analysis. Lancet 2011; 378:1306–­1315. McKnight RF...

Rapid-cycling bipolar affective disorder 316 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 Rapid-­cycling bipolar affective disorder Rapid-­cycling bipolar affective disorder is usually defined as bipolar disorder in which four or more episodes ...

References Bipolar disorder CHAPTER 2 References Miola A, et al. Prevalence and outcomes of rapid cycling bipolar disorder: mixed method systematic meta-­review. J Psychiatr Res 2023; 164:404–­415. Coryell W, et al. The long-­term course of rapid-­cycling bip...

Bipolar depression

Meta-analysis in bipolar depression Bipolar disorder CHAPTER 2 Bipolar depression Bipolar depression shares the diagnostic criteria for an episode of major depressive disorder, but episodes may differ in severity, time course, liability to recurrence and respo...

Summary of drug choice

References 322 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 Summary of drug choice The combination of olanzapine + fluoxetine is probably the most effective treatment available for bipolar depression but its use is constrained by the well-­know...

Prophylaxis in bipolar disorder 326 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 Prophylaxis in bipolar disorder Any successful drug regimen used for an acute episode should be continued as prophylaxis. To a large extent, therefore, the choice ...

Optimising lithium treatment45

Combination treatment Bipolar disorder CHAPTER 2 risperidone LAI is well supported by RCTs39 and naturalistic studies.40 The prescribing of LAI SGAs is generally encouraged despite some labelling restrictions41–­44 (see ‘Antipsychotic long-acting injections in...