Manic patients are a pain in the butt. They're no more annoying to treat than, say, people with schizophrenia, but they are a pain to keep on the unit with the other patients. If you have a group of sick people who are confined to an inpatient psych ward to provide a calm, healing environment, having a patient (or two!) that physically can't stop talking and pestering and advising and touching and... It get's on both the patients' and staff's nerves. Sometimes half the battle for the nursing staff is just keeping the peace between patients.
TIL: When transitioning from oral dosing to long-acting injections of paliperidone (Invega®), an atypical antipsychotic, you start with a loading dose of 234mg, then on day 8 you give a 156mg booster, and then on day 36 you start the regular monthly dose which can vary from 78 to 234mg.
In a previous post, I mentioned that lithium gets a bad rap as a dangerous drug during pregnancy. At the time, I mentioned that untreated bipolar is more dangerous than the tiny risk of an obscure birth defect associated with lithium use. This is still true, but additionally, all the other mood stabilizing drugs we use to treat bipolar disorder cause other birth defects and at greater rates. Valproic acid (Depakote®) and carbamazepine cause neural tube defects like spina bifida in 3-5% and 1% of pregnancies, respectively. By comparison, studies have shown lithium's Ebstein anomaly happens only 0.05-0.005% of the time.
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