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Acute manic symptoms of agitation and psychosis may be treated initially with the atypical antipsychotic olanzapine, (eg, 5 20 mg orally), risperidone (2 3 mg orally), or aripiprazole (15 30 mg) in conjunction with a benzodiazepine if indicated Alternatively, when behavioral control is immediately necessary, olanzapine in an injectable form (25 10 mg intramuscularly) or haloperidol, 5 10 mg orally or intramuscularly repeated as needed until symptoms subside, may be used The dosage of the neuroleptic may be gradually reduced after lithium or another mood stabilizer is started (see below) Olanzapine is approved as a maintenance treatment for bipolar disorder

Clonazepam can be an alternative or adjunct to a neuroleptic in controlling acute behavioral symptoms Clonazepam has the advantage of causing no extrapyramidal side effects Although 1 2 mg orally every 4 6 hours may be effective, up to 16 mg/d may be necessary

Flexible use of appropriate social services can be of major importance in the treatment of depression Since alcohol is often associated with depression, early involvement in alcohol treatment programs such as Alcoholics Anonymous can be important to future success (see Alcohol Dependency and Abuse, below) The structuring of daily activities during severe depression is often quite difficult for the patient, and loneliness is often a major factor The help of family,

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C# has many different operators that you ll learn about in this chapter. There s a full set of mathematical operators, and a related set of operators just for incrementing and decrementing in integral values by one, which actually are quite useful for controlling loops, as you ll learn in 5. Operators are also available for comparing two values that are used in the branching statements, as we ll also demonstrate in 5.

As a prophylactic drug for bipolar affective disorder, lithium significantly decreases the frequency and severity of both manic and depressive attacks in about 70% of patients A positive response is more predictable if the patient has a low frequency of episodes (no more than two per year with intervals free of psychopathology) A positive response occurs

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