18.104.22.168 Treatment of the acute phase of mania
- Refer all people in a hypomanic or manic episode for specialist mental health assessment. Contact a mental health specialist for advice on initial management while the person is waiting to be seen in secondary care. An antipsychotic may sometimes be recommended in the interim.
- Primary treatment for hypomania or mania is usually with an antipsychotic agent. See NICE CG 185 Bipolar disorder.
- If the person is already taking lithium, check plasma lithium levels to ensure they are within therapeutic range and to check concordance.
- Consider stopping antidepressant (on specialist advice).
- Modified release preparations of quetiapine should be reserved for patients with compliance issues.