14.6 : 躁病および抗躁薬: 概要

Mania is a psychological condition characterized by heightened mood, expanded energy, or irritability, and a reduced need for sleep.

It is a key phase of bipolar disorder, managed with mood stabilizers like lithium, antipsychotics, and anticonvulsants.

Lithium carbonate is the most effective prophylactic medication for bipolar disorder.

Its mechanism involves inhibiting inositol monophosphatase and increasing IP₃ accumulation. It also impacts monoamines and decreases arachidonic acid turnover.

However, lithium treatment shows adverse effects like fine hand tremors, dizziness, xerostomia, GI distress, sedation, and weight gain when combined with antipsychotics.

Continuous monitoring of serum lithium levels is vital, as toxicity can occur at concentrations above 1.5 mEq/L, necessitating dialysis.

Antipsychotic drugs like clozapine, olanzapine, and lurasidone help manage refractory and acute mania, either individually or as an adjunct therapy.

Anticonvulsants such as valproic acid compounds, carbamazepine, and lamotrigine help manage pediatric bipolar disorder acute mania and are maintenance treatments for bipolar disorder.