Typical and atypical antipsychotics in acute mania: Comparison of effectiveness

Introduction Mania is challenging to treat. Typical antipsychotics may be more efficient compared with atypical antipsychotics, however, with unfavourable side effects. Objectives To help the clinician choose between typical and atypical antipsychotics. Aims To investigate the correlation between change in severity of mania and the corresponding day to day use of typical and atypical antipsychotics. Methods This retrospective case record study included patients admitted with mania (International Classification of Diseases 10th revision code F30, F31.0, F31.1, F31.2 or F31.6) at the Department of Affective Disorders, Aarhus University Hospital, Denmark, between January 2013, and December 2015. The dose of typical and atypical antipsychotics was standardized as defined daily dose according to the World Health Organizationu0027s guidelines. The severity of mania was measured daily with the Modified Bech-Rafaelsen Mania Scale (MAS-M), a validated, nurse administered scale (MAS-M). We applied a linear regression in a mixed model approach to compare the Mas-M score over time under the influence of typical and atypical antipsychotics, respectively, adjusted for baseline characteristics. Results We included 43 patients. Patients receiving typical antipsychotics had more recent hospital admissions, a higher dosage antipsychotics and more constraint. The baseline MAS-M score was higher in patients receiving typical antipsychotics. The daily change in MAS-M score was–0.25 for typical antipsychotics and–0.23 for atypical antipsychotics with a difference of 0.02 (95% CI 0.008–0.039). Conclusions The rate of improvement of mania may be independent of baseline illness or type of antipsychotic medication. This may be confounded by indication.