From the Guidelines
The treatment of mania associated with hydrocephalus requires a multifaceted approach, addressing both the underlying hydrocephalus and the manic symptoms, with neurosurgical intervention and mood stabilizers such as valproate or lithium being essential components. The management of hydrocephalus typically involves placement of a ventriculoperitoneal (VP) shunt or endoscopic third ventriculostomy to reduce intracranial pressure, as recommended by studies such as 1 and 1. For acute management of manic symptoms, mood stabilizers such as valproate (starting at 250-500mg twice daily, titrating to therapeutic levels of 50-100 μg/mL) or lithium (starting at 300mg twice daily, titrating to levels of 0.6-1.0 mEq/L) are recommended, based on guidelines from 1. Some key points to consider in the treatment approach include:
- Atypical antipsychotics like risperidone (1-3mg daily) or olanzapine (5-10mg daily) may be added for severe symptoms, as suggested by 1.
- Lower initial doses are advisable due to potential increased sensitivity in patients with neurological conditions.
- Close monitoring is crucial as hydrocephalus can alter medication metabolism and blood-brain barrier permeability.
- Regular neurological assessments should be performed to evaluate shunt function and intracranial pressure, as worsening hydrocephalus can exacerbate psychiatric symptoms. The treatment approach should be collaborative between neurosurgery and psychiatry teams, with medication adjustments based on symptom response and potential side effects, as implied by the need for a comprehensive approach in studies such as 1 and 1. Improvement in manic symptoms often correlates with successful management of hydrocephalus, highlighting the importance of treating the underlying neurological condition, which is supported by the general principles of managing conditions with both neurological and psychiatric components, as discussed in 1.
From the FDA Drug Label
Lithium is indicated in the treatment of manic episodes of Bipolar Disorder. Olanzapine (in a dose range of 5-20 mg/day, once daily, starting at 10 mg/day) combined with lithium or valproate (in a therapeutic range of 0.6 mEq/L to 1. 2 mEq/L or 50 μg/mL to 125 μg/mL, respectively) was superior to lithium or valproate alone in the reduction of Y-MRS total score
The treatment for mania is lithium or olanzapine in combination with lithium or valproate. However, there is no information about the treatment of mania in patients with hydrocephalus. 2 3
From the Research
Treatment for Mania in Patients with Hydrocephalus
- The treatment for mania in patients with hydrocephalus is not directly addressed in the provided studies, but some information can be inferred from the available data 4, 5, 6, 7, 8.
- According to 4, for severe nonpsychotic mania, the experts recommend a mood stabilizer plus an antipsychotic (57%; first line) or a mood stabilizer alone (48%; first line) and would discontinue any antidepressant the patient is receiving.
- For psychotic mania, treatment of choice is a mood stabilizer plus an antipsychotic (98%; first line) 4.
- Risperidone (1.25-3.0 mg/day) and olanzapine (5-15 mg/day) were first-line options in combination with a mood stabilizer for mania with psychosis, with quetiapine (50-250 mg/day) high second line 4.
- Atypical antipsychotics, including risperidone, olanzapine, ziprasidone, and quetiapine, are effective for the treatment of acute mania 5.
- Psychiatric symptoms, including mania, are present in most patients with idiopathic normal pressure hydrocephalus 6, 7.
- Early diagnosis and treatment of hydrocephalus can prevent delays and improve patient outcomes, including those with mania symptoms 7.
- Treatment of hydrocephalus in patients with severe disorders of consciousness, including those with mania, can significantly improve patients' consciousness and neurological function 8.