[Treatment of a first manic episode]

Abstract

When the first episode of mania is not directly related to a somatic or toxic disease it indicates bipolar disorder. These former possibilities must always be excluded from a laboratory and morphological assessment. They are clinically difficult to identify mostly because the clinical presentation is usually atypical. Whilst they may occur at any age they mostly involve young people, and drug use is common. Psychotic presentations are particularly common as are some symptoms such as irritability. Treatment of the acute phase is no different from that of other manic episodes although the challenges are very different as whilst there is often a risk of functional deterioration after an initial episode this risk increases considerably with repeated episodes. It is therefore essential to establish a quality treatment alliance as soon as possible which will facilitate the introduction, acceptance and adherence to preventative treatment and adherence to the different lifestyle recommendations. Clinical studies are needed in order to provide more information about the most suitable preventative treatment in this population.