PRACTICE OF INPATIENT ACUTE TREATMENT OF MANIAS

We reviewed the literature regarding acute therapy of manic patients a nd compared these recommendations with actual practice by reviewing 39 9 therapies in 100 patients each from two psychiatric care centres bet ween 1975 und 1991. Higher age, more serious disease and a higher perc entage of compulsory commitments are typical of patients treated in in stitutions with a mandatory admission policy as compared to university clinics, which are not compelled to admit patients. The treatment met hods practised in both centres deviated greatly from recommendations i n the literature. In spite of widespread therapeutic recommendations, lithium and carbamazepin are seldom employed for acute treatment; neur oleptic agents were preferred for all grades of severity. Combinations of more potent antipsychotics with more sedative neuroleptics were pr eferred. In contrast, the chosen substances, the preferred combination s and the application form varied considerably. The state mental hospi tal preferred haloperidol and levomepromazin; in the university clinic clozapin and perphenazineoenanthate were important adjuncts. Both cli nics remained in the low therapeutic range of dose recommendations. Th ere were no statistically meaningful differences with regard to either the total amount of chlorpromazine equivalents applied or the duratio n of inpatient care. In the first one-tenth of the total treatment per iod, 85% of the maximal dose reached in the second tenth is already gi ven. A continual reduction begins thereafter, until app. 40% of the pe ak dose in reached. Active treatment of side effects as well as more c ommon use of depot neuroleptics in order to minimize custodial treatme nt, may explain the lower number of compulsory admissions in the unive rsity hospital. Extreme interindividual differences in both dosage and length of stay help in elucidating the apparently contradictory resul ts of comparative investigations with small patient groups. Previous t reatments have little or no predictive value due to large intraindivid ual variations.