Comparative Treatment Outcomes of Acute Manic Episodes with Antipsychotic Monotherapy Versus Combination Therapy with Mood Stabilizers: A Quasi-Experimental Study
DOI:
https://doi.org/10.51253/pafmj.v76iSUPPL-6.14127Keywords:
Acute mania, Antipsychotics, Bipolar disorder, Mood stabilizer, Psychotherapy, Young Mania Rating Scale (YMRS)Abstract
Objective: To study the comparison in effectiveness of monotherapy (Antipsychotic) versus combination therapy (antipsychotic with mood stabilizer) in acute mania.
Study Design: Quasi-Experimental study.
Place and Duration of Study: Department of Psychiatry, Armed Forces Institute of Mental Health, Rawalpindi, Pakistan, from Dec 2024 to Nov 2025.
Methodology: One hundred sixty patients aged 18-65 years, diagnosed with acute manic episode, having a baseline Young Mania Rating Scale (YMRS) score ≥ 20 at presentation, were included. The severity of mania was assessed using the Young Mania Rating Scale (YMRS) at baseline. Patients were allocated into two groups: Group-A (antipsychotic monotherapy) and Group-B (combination of antipsychotic plus mood stabilizer). At discharge, the YMRS score was reassessed to determine symptom improvement. Intergroup comparisons and logistic regression analysis were done.
Results: A total of 160 patients with acute manic episodes were enrolled in a 1:1 ratio. Baseline Median YMRS was 32.00 (15.00) in Group-A and 32.50 (12.00) in Group-B (p=0.91). Median YMRS decreased from 32.00 (15.00) to 22.00 (8.00) in Group-A and from 32.50 (12.00) to 19.00 (7.00) in Group-B. The reduction in YMRS (Δ) was greater with combination therapy 14.00 (5.00) vs 9.50 (6.00) with a significant between-group difference (both discharge scores and Δ: p<0.001). The proportion achieving ≥50% YMRS reduction was 0/80 (0.0%) in Group-A vs 15/80 (18.8%) in Group-B (p<0.001).
Conclusion: Combination therapy (antipsychotic with mood stabilizer) had a higher rate of acute manic episode control and reduction in YMRS score as compared to monotherapy (antipsychotics).
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Copyright (c) 2026 Maria Zia, Ahmed Shoaib , Syeda Rabbia Siab, Rabiya Adnan, Sana Zahra, Ishel Farid
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