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Selective serotonin reuptake inhibitor (SSRI)
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Serotonin-norepinephrine reuptake inhibitor (SNRI)
Benzodiazepine
Zolpidem
Antipsychotic
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This patient presents with agitation and signs of acute mania. Initial management calls for treatment with an antipsychotic. A manic episode is defined as a period of seven or more days of elated or irritable mood, where the mood is not caused by drugs/medication or a medical illness (e.g., hyperthyroidism), and (a) is causing obvious difficulties at work or in social relationships and activities, or (b) requires admission to hospital to protect the person or others, or (c) the person is suffering psychosis. Antipsychotics such as haloperidol are acute in onset and are the agent of choice in initial management of extreme agitation due to mania. Price et al. review bipolar disorder. Following initial management of acute mania, mood-stabilizing agents, such as lithium and anticonvulsants, should be continued indefinitely in affected patients. Yildiz et al. found in a meta-analysis of 10,800 patients that most clinically used antimanic treatments, including haloperidol, risperidone, and others, are more efficacious in treating manic episodes than placebo. Incorrect Answers: Answers 1 and 2: SSRI's and SNRI's are used to treat depression. They may worsen episodes of acute mania. Answers 3 and 4: Zolpidem and benzodiazepines can be used as adjunctive therapy to aid with insomnia and agitation but are not first line agents when treating an acute manic episode.
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