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Module 3Indications for Antipsychotics

Bipolar DisorderFlavio Guzmn, MD

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Outline

Indications of antipsychotics in differentphases of bipolar disorder: Mania/mixed states

Bipolar depression

Maintenance treatment

FDA approved agents for each phase

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Use of antipsychotics in bipolar diso

Bipolar depression

Mania Mixed states

Mainte

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Mania Management

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Acute mania pharmacother

Patients with BD spend much less time mania, hypomania, or mixed states tha

do in depression.

Many effective treatments for mania, fefor maintenance treatment or treatmen

bipolar depression.

Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of ClinicaPsychopharmacology. 7th ed.American Psychiatric Publishing

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Acute mania pharmacother

FGAs SGAs

Anticonvulsants Lithium

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Antipsychotics for mania

FGAs are effective in the treatment of mbut are frequently avoided due to the r

EPS.

Antipsychotics work as well as lithium iacute mania, even in the absence of

psychotic symptoms.

Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of ClinicaPsychopharmacology. 7th ed.American Psychiatric Publishing

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FGAs treatment

Patients with mood disorders might mo

vulnerable to developing TD than

schizophrenia patients.

Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of ClinicaPsychopharmacology. 7th ed.American Psychiatric Publishing

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Mixed Episodes

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FDA approved SGAs for

manic/mixed episodes

Manic/mixed ep

Aripiprazole

Asenapine

Quetiapine andquetiapine XR

Risperidone Olanzapine

Ziprasidone

Frye MA. Clinical practice. Bipolar disorder--a focus on depression

N Engl J Med. 2011;364(1):51-9.

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The role of SGAs in the treatment of manic/mixed e

Manic/mixed episodes

Aripiprazole

Asenapine

Quetiapine and quetiapine XR

Risperidone

Olanzapine

Ziprasidone

Manic/mixed episodes

Aripiprazole

Asenapine

Quetiapine and quetiapine XR

Risperidone

Olanzapine

Ziprasidone

LithiumD

Approved as

monotherapy

Approved as

adjunctive

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Bipolar Depression

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Bipolar depression

Depression is the predominant mood stbipolar disorder.

Some clinicians argue that this state is t

most difficult to treat. There are few proven strategies for bip

depression.

Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of ClinicaPsychopharmacology. 7th ed.American Psychiatric Publishing

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Bipolardepression

Quetiapine

Olanzapine/

fluoxetine

FDA approved SGAs forbipolar depression

Frye MA. Clinical practice. Bipolar disorder--a focus on depression

N Engl J Med. 2011;364(1):51-9.

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Maintenance treatment

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Maintenanctreatment

Aripiprazole

Olanzapine

Quetiapine anquetiapine XR

Risperidone (L

Ziprasidone

FDA approved SGAs for

maintenance

treatment

Frye MA. Clinical practice. Bipolar disorder--a focus on depression

N Engl J Med. 2011;364(1):51-9.

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Maintenance treatment: SG

Advantages

Titration is rapid andeasier. (Compared to

lamotrigine andlithium)

Safer in overdose

Disadvantage

Weight gain

Metabolic side

effects Sedation

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Take home points

Antipsychotics are effective for mania, mistates and bipolar depression.

Bipolar depress

Quetiapine

Olanzapine /fluoxetine

Manic/mixed episodesc

Aripiprazole

Asenapine

Quetiapine andquetiapine XR

Risperidone

Olanzapine

Ziprasidone

Maintenancetreatment

AripiprazoleOlanzapine

Quetiapine andquetiapine XR

Risperidone (LAI)

Ziprasidone

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References and further read

Frye MA. Clinical practice. Bipolardisorder--a focus on depression. N EnglMed. 2011;364(1):51-9.

Schatzberg, AF., Cole, JO, and DeBattist

C. Manual of ClinicalPsychopharmacology. 7th ed.AmericanPsychiatric Publishing, 2010.