Letters to the Editor
Risperidone Liquid Treatment of Acute Mania
Dear Editor:
The following case history may appear anecdotal, but it nevertheless sheds some light on an aspect of treating acute mania.
Mrs WP, aged 69 years, was admitted to the psychiatric unit of our hospital with symptoms consistent with acute mania. She exhibit grandiose ideation, euphoria, psychomotor excitement, flight of ideas, and pressure of speech. She also exhibited overt sexual acts, such as running nude in the unit. This patient has a long history of bipolar affective disorder type 1, and she has been followed up in the community. According to the history gathered, she was receiving gabapentin 300 mg 3 times daily, to which she became noncompliant.
While in the hospital, she showed no insight and felt that there was nothing wrong. She wanted to walk nude, arguing that there are nude beaches in the world, and therefore, nudity should be acceptable in the psychiatric unit. She refused to take any medication, again claiming that there was nothing wrong with her. She became hostile, and I had to use intramuscular benzodiazepine treatment. Her Young Mania Rating Scale (YMRS) score was 48, which is consistent with severe mania. She was started back on gabapentin and also received risperidone liquid 1 mg twice daily. After 2 doses of risperidone, which were administered with difficulty, she showed a dramatic response. Her psychomotor excitement and inappropriate sexual behaviours totally disappeared, and she started to sleep well. Two days later, her YMRS score was was 17.
Although antipsychotics are frequently used to control psychotic agitation, risperidone was found to be unique in this case. Certainly, it stabilized her mood within a couple of days and with only 2 doses. Given this case report, it may be wise to consider risperidone liquid as a first choice in the case of acute mania, in addition to any other mood stabilizer.
TM Abraham, MD, FRCPC
Welland, Ontario
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