The typical antipsychotic agents co...

The typical antipsychotic agents continue to be used in the acute mania phase of patients with bipolar disorder to provide rapid regulate of acute mania symptoms. freshly questions have been raised concerning the safety of these agents in patients with bipolar disorder. Many researchers have adviseed that the typical antipsychotic agents may worsen the course of bipolar disorder from switching patients into depression and increasing their risk of depressive episodes and rapid cycling. These agents also have safety issues, particularly those of acute extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome The newer, atypical antipsychotic agents have a lower risk of side forces compared with the older, typical agents. However, there is limited literature available evaluating these pair classes of medications in the treatment of patients with bipolar disorder. Tohen and associates evaluated the safety and efficacy of olanzapine (an atypical antipsychotic agent) and haloperidol (a typical antipsychotic agent) in patients diagnosed with acute mania.

The trial was a 12-week, multicenter, randomized, double-blind, parallel form into groups study of patients who met the criteria for bipolar I disorder, manic or mixed symbol (with or without psychotic features) in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV). Participants were included if they had a mania score of 20 or higher in succession mania phase. Patients were assessed at baseline and randomized to receive olanzapine (5 10 15 or 20 mg by day) or haloperidol (3, 5 10 or 15 mg through day). Dosages were adjusted during the research period based on the clinical estimate of the attending physician.

Participants were assessed in succession a weekly basis with multiple standardized examines including one for quality of life. Patients who showed improvement in mania score at week 6 were allowed to consummate the study; patients whose score did not improve were exclud from the final six-week continuation phase of the studious mood Adverse events were recorded at each visit, and vital signs, weight, and clinical laboratory experiments were assessed at baseline, and at weeks 6 and 12 or when the patient discontinued randomized therapy.

There were 453 participants in the subject of attention The rates of remission of mania symptoms were not significantly different in the olanzapine clump than in the haloperidol arrange There was a significant increase in the risk of rapid switching to depression and a significant worsening of extrapyramidal symptoms in those receiving haloperidol compared with those receiving olanzapine. Participants were more likely to have a weight gain with olanzapine. Participants who received olanzapine had a statistically significant greater improvement upon quality-of-life measurement scores. The authors judge that olanzapine and haloperidol provide similar rates of remission in patients in the acute mania phase of bipolar disorder. They add that olanzapine does have a lower risk for extrapyramidal symptoms, if it be not that also has a higher risk of weight gain compared with haloperidol.

KARL E MILLER, MD

Tohen M et al. A 12-week, double-blind comparison of olanzapine v haloperidol in the treatment of acute mania. Arch Gen Psychiatry December 2003;60:1218-26

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