Principles of managing acute mania in children

For multifaceted management of bipolar disorder that is not restricted to an episode of acute mania, see Principles of managing bipolar disorder in children.

Acute mania is extremely rare in children and treatment should always be provided by a service with practitioners experienced in treating bipolar disorder in children. Treatment in hospital is usually necessary.

Principles of treating acute mania in children are similar to those for adults and young people but there is less evidence to support the efficacy of the interventions in children.

• There is some randomised controlled trial data for the efficacy of:
  • monotherapy with aripiprazole, olanzapine, quetiapine, risperidone and ziprasidone
  • combination therapy with an antipsychotic and either sodium valproate or carbamazepine.
• There is limited evidence to support combining an antipsychotic with lithium.
• Despite being widely used, evidence for monotherapy with lithium, sodium valproate or carbamazepine is limited to open-label studies.
• Children appear to be at higher risk of antipsychotic adverse effects including extrapyramidal adverse effects, effects due to elevated blood prolactin concentration, and weight gain; see Antipsychotic adverse effects.