Page 25 - TRAMES-BP®

Treatment implications of bipolar mixed state

diagnosis in patients with psychotic features

• Antipsychotics may induce depression or

negative symptoms (go slow, stay low)

• Less responsive to classic mood stabilisers

• Carbamazepine

• Combination of mood stabilisers

(lithium + valproate, Li + carbamazepine,

Quetiapine + valproate…)

• ECT should not be considered a “last resort”

Perugi G et al. J Affect Disord 2001; 67:105–14;
Akiskal and Mallya, Psychopharm Bull 1987; 23:68-73;
Koukopoulos et al., Encéphale 1992; 18:19-21;
Benazzi F. and Akiskal H.S. J Affect Disord 2001; 67(1-3):115-22