Mania: Treatment overview
The treatment algorithm for acute mania was developed for psychiatrists treating bipolar mania. Its latter steps are beyond the clinical practice of most primary care physicians.
The first task is to determine the best treatment setting for the patient. Safety concerns related to self-harm or harm to others, as well as neglect of personal care often provide the basis for immediate hospitalization.
Discontinuing antidepressants is often a helpful first step in reducing manic severity. But in most severe and complex presentations of mania, removing the antidepressant and discontinuing caffeine, alcohol and illicit substances are rarely sufficient for rapid symptom control.
Many individuals experiencing mania are very distressed by their behaviour and by psychopathological symptoms, such as psychosis. You should provide empathic reassurance and attempt to engage the patient in supportive ways. Offer education around the cause of the disturbance and discuss treatment options.
Behavioural strategies for managing mania include establishing normal daily rhythms, with special emphasis on sleep hygiene and appropriate nutritional intake and hydration and energy expenditure.
Bipolar disorder: Assessment and management (NICE guideline CG185, 2014)