Bowden C L
Department of Psychiatry, University of Texas Health Science Center at San Antonio 78284-7792, USA.
J Clin Psychiatry. 1996;57 Suppl 13:4-9; discussion 10-2.
Mania is one of the few emergent conditions in psychiatry. Vigorous treatment, aimed at achieving symptom control as promptly as possible while avoiding adverse effects, is therefore important. Strategies to accomplish this aim are possible, but differ for each of the three antimanic drugs principally employed. For lithium, uncomplicated manic patients can be started at 15 mg/kg of body weight, with dosage increase every 3 to 4 days until response, complicating adverse effects, or a serum level of 1.2 to 1.4 mEq/L occurs. Valproate, if administered as divalproex, can usually be initiated at a dosage of 20 mg/kg of body weight, which is associated with earlier improvement than that observed with lithium. Carbamazepine requires a relatively slow dosage escalation from an initial 200 mg once or twice daily, due to the possibility of neuromuscular and cognitive adverse effects. Adjunctive medications are frequently necessary and add to the importance of a thorough knowledge of the dosing strategies needed at different points in early therapy of bipolar disorder.
躁狂症是精神病学中少数几种紧急病症之一。因此，积极治疗很重要，其目标是尽快控制症状，同时避免不良反应。实现这一目标的策略是可行的，但主要使用的三种抗躁狂药物各有不同。对于锂盐，无并发症的躁狂患者起始剂量可为15mg/kg体重，每3至4天增加剂量，直至出现疗效、出现复杂的不良反应或血清水平达到1.2至1.4mEq/L。丙戊酸盐若以丙戊酸镁形式给药，通常起始剂量为20mg/kg体重，与锂盐相比，其改善情况出现得更早。卡马西平由于存在神经肌肉和认知方面不良反应的可能性，需要从初始的每日200mg一次或两次开始相对缓慢地增加剂量。辅助药物常常是必要的，这也凸显了全面了解双相情感障碍早期治疗不同阶段所需给药策略的重要性。
