The aim of management is to treat acute episodes safely with medication and work with the patient in long-term maintenance to prevent further episodes and optimise function using a combination of pharmacological and psychotherapeutic techniques. Hospitalization may be required especially with the manic episodes present in<unk>  I. This can be voluntary or (local legislation permitting) involuntary. Long-term inpatient stays are now less common due to deinstitutionalization, although these can still occur. Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or an Assertive Community Treatment team, supported employment, patient-led support groups, and intensive outpatient programs. These are sometimes referred to as partial-inpatient programs. Psychosocial Psychotherapy aims to assist a person with<unk>  in accepting and understanding their diagnosis, coping with various types of stress, improving their interpersonal relationships, and recognizing prodromal symptoms before full-blown recurrence. Cognitive behavioral therapy, family-focused therapy, and psychoeducation have the most evidence for efficacy in regard to relapse prevention, while interpersonal and social rhythm therapy and cognitive-behavioral therapy appear the most effective in regard to residual depressive symptoms. Most studies have been based only on<unk>  I, however, and treatment during the acute phase can be a particular challenge. Some clinicians emphasize the need to talk with individuals experiencing mania, to develop a therapeutic alliance in support of recovery. Medication Lithium is often used to treat<unk>  and has the best evidence for reducing suicide. Medications are often prescribed to help improve symtoms of<unk> . Medications approved for treating<unk>  including mood stabolizers, antipsychotics, and antidepressants. Sometimes a combination of medications may also be suggested. The choice of medications may differ depending on the<unk>  episode type or if the person is experiencing unipolar or<unk>  depression. Other factors to consider when deciding on an appropriate treatment approach includes if the person has any comorbidities, their response to previous therapies, adverse effects, and the desire of the person to be treated. Mood stabilizers Lithium and the anticonvulsants carbamazepine, lamotrigine, and valproic acid are classed as mood stabilizers due to their effect on the mood states in<unk> . Lithium has the best overall evidence and is considered an effective treatment for acute manic episodes, preventing relapses, and<unk>  depression. Lithium reduces the risk of suicide, self-harm, and death in people with<unk> . Lithium is preferred for long-term mood stabilization. Lithium treatment is also associated with adverse effects and it has been shown to erode kidney and thyroid function over extended periods. Valproate has become a commonly prescribed treatment and effectively treats manic episodes. Carbamazepine is less effective in preventing relapse than lithium or valproate. Lamotrigine has some efficacy in treating depression, and this benefit is greatest in more severe depression. It has also been shown to have some benefit in preventing<unk>  relapses, though there are concerns about the studies done, and is of no benefit in rapid cycling subtype of<unk> . Valproate and carbamazepine are teratogenic and should be avoided as a treatment in women of childbearing age, but discontinuation of these medications during pregnancy is associated with a high risk of relapse. The effectiveness of topiramate is unknown. Carbamazepine effectively treats manic episodes, with some evidence it has greater benefit in rapid-cycling<unk> , or those with more psychotic symptoms or more symptoms similar to that of schizoaffective disorder. Mood stabilizers are used for long-term maintenance but have not demonstrated the ability to quickly treat acute<unk>  depression. Antipsychotics Antipsychotic medications are effective for short-term treatment of<unk>  manic episodes and appear to be superior to lithium and anticonvulsants for this purpose. Atypical antipsychotics are also indicated for<unk>  depression refractory to treatment with mood stabilizers. Olanzapine is effective in preventing relapses, although the supporting evidence is weaker than the evidence for lithium. A 2006 review found that haloperidol was an effective treatment for acute mania, limited data supported no difference in overall efficacy between haloperidol, olanzapine or risperidone, and that it could be less effective than aripiprazole. Antidepressants Antidepressants are not recommended for use alone in the treatment of<unk>  and do not provide any benefit over mood stabilizers. Atypical antipsychotic medications (e.g., aripiprazole) are preferred over antidepressants to augment the effects of mood stabilizers due to the lack of efficacy of antidepressants in<unk> . Treatment of<unk>  using antidepressants carries a risk of affective switches; where a person switches from depression to manic or hypomanic phases. The risk of affective switches is higher in<unk>  I depression; antidepressants are generally avoided in<unk>  I disorder or only used with mood stabilizers when they are deemed necessary. There is also a risk of accelerating cycling between phases when antidepressants are used in<unk> . Combined treatment approaches Antipsychotics and mood stabilizers used together are quicker and more effective at treating mania than either class of drug used alone. Some analyses indicate antipsychotics alone are also more effective at treating acute mania. A first-line treatment for depression in<unk>  is a combination of olanzapine and fluoxetine. Other drugs Short courses of benzodiazepines are used in addition to other medications for calming effect until mood stabilizing become effective. Electroconvulsive therapy (ECT) is an effective form of treatment for acute mood disturbances in those with<unk> , especially when psychotic or catatonic features are displayed. ECT is also recommended for use in pregnant women with<unk> . It is unclear if ketamine (a common general dissociative anesthetic used in surgery) is useful in<unk> . Children Treating<unk>  in children involves medication and psychotherapy. The literature and research on the effects of psychosocial therapy on<unk>  spectrum disorders are scarce, making it difficult to determine the efficacy of various therapies. Mood stabilizers and atypical antipsychotics are commonly prescribed. Among the former, lithium is the only compound approved by the FDA for children. Psychological treatment combines normally education on the disease, group therapy, and cognitive behavioral therapy. Long-term medication is often needed. Resistance to treatment The occurrence of poor response to treatment in has given support to the concept of resistance to treatment in<unk> . Guidelines to the definition of such treatment resistance and evidence-based options for its management were reviewed in 2020.
Bipolar disorder
Substance use disorder
Major depressive disorder
Attention deficit hyperactivity disorder
Bipolar I disorder
Schizophrenia
Major depressive episode
Personality disorder