 Confirm diagnosis

 Hospitalisation
-severe mania, violence, sexual indiscretions,
patients refuse treatment
 Treat mania or/and psychosis
 Treat depression
 Treat mixed states
 Maintenance therapy
 Non-pharmacological treatment
 Antipsychotic: haloperidol(typical),
aripiprazole,olanzapine, risperidone,
ziprasidone,quetiapine
 Mood stabilisers: sodium valproate or
carbamazepine monotherapy
 Combination of antipsychotic and mood
stabiliser if inadequate response to mood
stabiliser monotherapy
 Agitation: haloperidol(IM/oral),
olanzapine(oral), clonazepam or
lorazepam(IM/oral)
 Antidepressants: SSRIs (eg: Fluoxetine)
 Mood stabilisers: Lithium(monotherapy with
sodium calproate or carbamezapine is not
recommended due to conflicting evidence of
efficacy)
 Antipsychotics: quetiapine or olanzapine
monotherapy, olanzapine-fluoxetine
combination
 Psychotherapy(eg: CBT)
  Non-pharmacological treatments should not
be used due to insufficient evidence.

Mixed States
• Mood stabilisers: Sodium valproate or
carbamazepine
 Lithium, valproate or olanzapine- preventing
relapse to either pole of bipolar disorder
 Aripiprazole- recent manic or mixed episode
 Quetiapine in combination with lithium or
valproate-bipolar I disorder
 In severe cases, the combination of lithium and
valproate should be a specialist’s decision
 A patient is advised to continue treatment for at least 2
years after an episode of bipolar disorder and up to 5
years if there is a significant risk of relapse
 Psychotherapy
 Cognitive therapy
 Behaviour therapy
 Psychoeducation/Support
 Family therapy
 School Support/Consultation
 Residential Placement, Acute Hospitalization
 Mood Charting
 Teach Good Sleep Hygiene
 Hope
 Relapse drills