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chotic disorders
F or s e v e r e a nxie ty or a gita tion, the follow ing c a n be a d d e d , for a s hor t p e r iod , a t
the
be ginning of the a ntip s yc hotic tr e a tm e nt:
– A n a nxiolytic , if the p a tie nt is a nxious :
diazepam P O : 5 to 1 5 m g/ d a y in 2 or 3 d iv id e d d os e s for a fe w d a ys
O nly us e the inje c ta ble for m in s e v e r e a nxie ty ( diazepam I M : 1 0 m g, to be
r e p e a te d
onc e a fte r one or tw o hour s , if ne c e s s a r y), the n c ha nge to d ia ze p a m P O a s
a bov e .
– A nothe r , m or e s e d a ting, a ntip s yc hotic if the p a tie nt is a gita te d :
chlorpromazine P O : 7 5 to 1 5 0 m g/ d a y in 3 d iv id e d d os e s for a fe w d a ys
– F or v e r y s e v e r e a gita tion, v iole nc e or op p os ition:
haloperidol I M : 5 m g + chlorpromazine I M : 2 5 m g, to be r e p e a te d on c e a fte r on e or
tw o hour s , if ne c e s s a r y.
In s uc h c a s e s , c ontinue w ith ha lop e r id ol P O r a the r tha n r is p e r id one (a nd if
ne c e s s a r y,
c ontinue c hlor p r om a zine P O a s a bov e for a fe w d a ys ).
B ip ola r d is or d e r is c h a r a c t e r is e d by a lt e r n a t in g m a n ic a n d d e p r e s s iv e
e p is od e s ,
Bipolar disorder
3
ge ne r a lly s e p a r a te d by “nor m a l” p e r iod s la s ting s e v e r a l m onths or ye a r s .
M a nic e p is od e s a r e c ha r a c te r is e d by e la tion, e up hor ia a nd hyp e r a c tiv ity
a c c om p a nie d
by ins om nia , gr a nd ios e id e a s , a nd los s of s oc ia l inhibitions (s e xua l, in p a r tic ula r ).
D e p r e s s iv e e p is od e s a r e ofte n s e v e r e , w ith s ignific a nt r is k of s uic id e .
P ha r m a c ologic a lly:
– M a nic e p is od e s a r e tr e a te d w ith risperidone P O : s ta r t a t a low d os e of 2 m g
onc e d a ily;
in c r e a s e if n e c e s s a r y in s t e p s of 1 m g/ d a y ( m a xim um d os e 6 m g/ d a y) for
3 to
6 w e e ks . T h e m e d ic a t ion s h ould be s t op p e d gr a d ua lly, m on it or in g for
p os s ible
r e la p s e .
– D e p r e s s iv e e p is od e s a r e tr e a te d a s d e p r e s s ion (s e e p a ge 2 9 7 ).
– T he p r im a r y tr e a tm e nt for bip ola r d is or d e r is a long-te r m m ood s ta bilis e r
(lithium or
c a r ba m a ze p ine ).
F or s e v e r e a nxie ty or a gita tion, the follow ing c a n be a d d e d , for a s hor t p e r iod , a t
the
be ginning of the a ntip s yc hotic tr e a tm e nt:
– A n a nxiolytic , if the p a tie nt is a nxious :
diazepam P O : 5 to 1 5 m g/ d a y in 2 or 3 d iv id e d d os e s for a fe w d a ys
O nly us e the inje c ta ble for m in s e v e r e a nxie ty ( diazepam I M : 1 0 m g, to be
r e p e a te d
onc e a fte r one or tw o hour s , if ne c e s s a r y), the n c ha nge to d ia ze p a m P O a s
a bov e .
– A nothe r , m or e s e d a ting, a ntip s yc hotic if the p a tie nt is a gita te d :
chlorpromazine P O : 7 5 to 1 5 0 m g/ d a y in 3 d iv id e d d os e s for a fe w d a ys
– F or v e r y s e v e r e a gita tion, v iole nc e or op p os ition:
haloperidol I M : 5 m g + chlorpromazine I M : 2 5 m g, to be r e p e a te d on c e a fte r on e or
tw o hour s , if ne c e s s a r y.
In s uc h c a s e s , c ontinue w ith ha lop e r id ol P O r a the r tha n r is p e r id one (a nd if
ne c e s s a r y,
c ontinue c hlor p r om a zine P O a s a bov e for a fe w d a ys ).
B ip ola r d is or d e r is c h a r a c t e r is e d by a lt e r n a t in g m a n ic a n d d e p r e s s iv e
e p is od e s ,
Bipolar disorder
3
ge ne r a lly s e p a r a te d by “nor m a l” p e r iod s la s ting s e v e r a l m onths or ye a r s .
M a nic e p is od e s a r e c ha r a c te r is e d by e la tion, e up hor ia a nd hyp e r a c tiv ity
a c c om p a nie d
by ins om nia , gr a nd ios e id e a s , a nd los s of s oc ia l inhibitions (s e xua l, in p a r tic ula r ).
D e p r e s s iv e e p is od e s a r e ofte n s e v e r e , w ith s ignific a nt r is k of s uic id e .
P ha r m a c ologic a lly:
– M a nic e p is od e s a r e tr e a te d w ith risperidone P O : s ta r t a t a low d os e of 2 m g
onc e d a ily;
in c r e a s e if n e c e s s a r y in s t e p s of 1 m g/ d a y ( m a xim um d os e 6 m g/ d a y) for
3 to
6 w e e ks . T h e m e d ic a t ion s h ould be s t op p e d gr a d ua lly, m on it or in g for
p os s ible
r e la p s e .
– D e p r e s s iv e e p is od e s a r e tr e a te d a s d e p r e s s ion (s e e p a ge 2 9 7 ).
– T he p r im a r y tr e a tm e nt for bip ola r d is or d e r is a long-te r m m ood s ta bilis e r
(lithium or
c a r ba m a ze p ine ).
