Abstract
In a closed inpatient unit, valproate and lithium were initially combined in the treatment
of 12 severely manic patients (ICD-10 F30, F31, F25). Onset of response and the use
of additional neuroleptic medication were analyzed. For 5 patients a comparision was
performed between the index episode and a pre-treatment period during which lithium
therapy was administered without valproate. Outcome criteria for the analysis were
the latency of response and remission, as well as the dose of neuroleptic medication
necessary for additional sedation. The mean severity of mania syndrome (AMDP-System)
in the study patients was comparable to the mean mania score of the total manic patient
population of the inpatient unit. All patients responded to the combination of valproate
and lithium, and the mean total-remission time was 30 days for the whole group. Mean
serum levels were 0.8 mmol/L for lithium and 73.8 mg/L for valproate. The mean remission
time for the 5 readmitted patients was 22.8 days under combination treatment compared
to 35.6 days in the pre-treatment episode without additional valproate (p = 0.06).
It was possible to markedly reduce the use of neuroleptic medication in these patients
from 18 601.6 mg CPZ equivalents to 3927.6 mg (p < 0.025). Initially combining valproate
and lithium thus appears to be an effective therapeutic option for the inpatient management
of severe manic syndromes.
