Geodon, or ziprasodone, is an antipsychotic medication that is also approved by the FDA for treatment of acute manic episodes, as stated in the FDA prescribing information. Several other treatments are also commonly used to treat acute mania, as well as two general classes of medication to treat psychosis. Mania occurs in patients with bipolar I disorder, and symptoms include a period of little sleep combined with greatly increased energy and rapid speech. Psychosis means a detachment from reality, often accompanied by delusions and hallucinations.
Treatment of Acute Mania
Acute mania is a period of tremendous, abnormal excitation, sometimes accompanied by grandiose thinking and delusions, meaning the patient might think they can fly. As explained in "Kaplan and Sadock's Comprehensive Textbook of Psychiatry," commonly used medications include lithium and depakote, which are considered mood stabilizers and are started during the acute manic episode and continued indefinitely once it subsides. If agitation is severe, and if it is accompanied by psychotic symptoms, other medications are often added during the acute phase. These include antipsychotics such as olanzapine and risperidone. Sometimes a benzodiazepine such as clonazepam is used to help the patient become more calm and to help him sleep.
Typical Antipsychotics
The typical antipsychotics include older drugs such as haloperidol, perphenazine and fluphenazine. They are used to treat short-term psychotic symptoms and chronic psychosis, meaning schizophrenia or schizoaffective disorders. This class of medication is particularly effective against hallucinations and delusions, collectively known as "positive symptoms" of psychosis. Some of these medications are available in long-acting forms that can be given to patients who are unable to adhere to oral medications. Side effects are primarily neurological, consisting of a variety of movement disorders, some appearing at the beginning of treatment, some after long-term use.
Atypical Antipsychotics
Atypical antipsychotics, often called simply "atypicals," are a newer class of antipsychotics that have less neurological side effects than the older drugs. Olanzapine, risperidone, seroquel and clozapine are some of these medications. They are used for the same indications as the typical antipsychotics, though clozapine is reserved for patients who have severe chronic psychosis and have not improved with trials of several other antipsychotics. According to "Kaplan and Sadock's Comprehensive Textbook of Psychiatry," atypicals have many metabolic side effects, and can lead to significant weight gain, diabetes and elevation of lipids. These should be monitored throughout the course of treatment, which is often lifelong. Clozapine tends to cause the greatest weight gain of them all, as well as having the potential to cause a dangerous drop in white blood cells, which can put the patient at risk for serious infections. It's also considered the most effective medication against negative symptoms, which include impoverished thinking and flat affect, meaning lack of any emotional expression.
References
- "Kaplan and Sadock's Comprehensive Textbook of Psychiatry"; Virginia Sadock and Pedro Ruiz (editors); 2009
- FDA: Geodon
