Acute Mania Rx — MRCPsych Paper B MCQ

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EasyMood DisordersAcute Mania RxMRCPsych Paper B

A 32-year-old adult with bipolar I disorder develops an acute manic episode. They are not currently taking an antipsychotic or mood stabiliser, and there is no immediate indication for rapid tranquillisation. Which pharmacological strategy should be offered first?

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Correct answer: E — Antipsychotic monotherapy

The correct answer is E. NICE recommends offering haloperidol, olanzapine, quetiapine or risperidone when an adult develops mania or hypomania while taking neither an antipsychotic nor a mood stabiliser. Selection should reflect preference, previous response, physical comorbidity and adverse-effect risks. Lamotrigine is used principally for bipolar depression and relapse prevention and should not be offered to treat acute mania. An SSRI can exacerbate manic symptoms and is not antimanic treatment. A benzodiazepine may sometimes be used briefly to manage associated agitation or insomnia but is not adequate monotherapy for the manic episode. Carbamazepine is not among NICE's recommended initial treatments in this situation.

Reference: National Institute for Health and Care Excellence. Bipolar disorder: assessment and management (CG185), section 1.5, recommendation 1.5.3. Updated 2025. https://www.nice.org.uk/guidance/cg185/chapter/Recommendations