Pharmacological management of manic psychosis in an unlocked setting

There has been a resurgence in the past few years of exploring alternative pharmacological agents in the management of manic psychosis. An open clinical trial was conducted on an unlocked ward investigating the use of benzodiazepines as adjunctive therapy with lithium or carbamazepine, with some of the patients also receiving neuroleptics. Twelve patients meeting DSM-III criteria for bipolar affective disorder, manic type, were treated. Patient response was monitored with use of the Brief Psychiatric Rating Scale and the Biegel Mania Rating Scale. The patients all had moderately severe illness upon initiation of the trial. Results indicate that those patients who received benzodiazepines alone were among the better responders, and that when used in combination with neuroleptics, the dose of each drug was quite small. Minimal side effects were noted with this regimen. Our preliminary results suggest that benzodiazepines may be useful as adjunctive treatment in the management of patients with bipolar affective disorder, manic type.