Child Psychology and Psychiatry

212

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Adolescence
Stage 2
Alternate mood stabiliser or atypical antipsychotic
Stage 3 
Alternate mood stabiliser and atypical antipsychotic 
Stage 4
Combination of two mood stabilisers & atypical antipsychotic
Stage 5
ECT (adolescents)
Clozapine
or
Stage 1
Monotherapy with mood stabilizer 
or
atypical
antipsychotic
∗
∗
Mood stabilizers – lithium; sodium valproate; carbamazepine
∗
Atypical antipsychotics – olanzapine; quetiapine; risperidone; aripirazole
Figure 33.1
Bipolar disorder type I (BPD-I), manic, mixed, without psychosis. ECT, electroconvulsive
therapy.
discontinuation of antipsychotic medication leads
to a recurrence of psychotic symptoms in a large
percentage of cases [28].
Opinion is that medication tapering or discon-
tinuation be considered if the patient has achieved
remission for a minimum of 12–24 consecutive
months. However, for many patients long-term
or even life-long pharmacotherapy might be
indicated.