[Acute mania. Clinical features and pharmacological treatment]

The bipolar disorder is a chronic disease and often a devastating one. The Physical and psychosocial impairments which are associated with a high percentage of medical and psychiatric care, family dysfunction, divorces, drug abuse and suicides are common. One of the mayor difficulties is the diagnosis. Numerous studies show the course of time that takes to reach a diagnosis. Empirical studies have tried to evaluate the characteristics of the atypical mania. Different authors have found that atypical mania features may coexist in some patients with mania, particularly those who experience a severe mania phase. The identification of factors and subtypes may be useful to identify atypical characteristics in patients with acute mania. This concept may be used for research developments that tend to establish rational strategies of treatment and the underlying biological substrates of every clinical subtype. There are several agents that may be used in treating acute mania, however, of practical importance is to determine which one is the most effective when deciding which one to choose. It is important to point out that in the daily practice multiple medication is the rule rather then the exception. The use of mood stabilizers is recommended in all phases of treatment with mono-therapy or combined therapies. Its is convenient to establish cathagoric ranks that include first line treatments as the preferred option, second line as the alternative choice and a third line as the inappropriate one.