Approach to Management Patients with mania are susceptible to overstimulation, and they fear the loss of control. To manage aggression in these patients, it is important to recognize impending overstimulation and immediately establish consistent behavioral limits and environmental structure. 15 Table 1 summarizes contributing factors to and countermeasures of aggressive behavior in manic episodes. Internal and external overstimulation can be countered by reducing environmental noise, providing a safe and predictable setting, and promoting an internal stimulus barrier with antiarousal medication. Fear of loss of control and impulsivity can be countered by controlling overstimulation and providing consistent behavioral limits.
Pharmacologic treatment helps to create an internal barrier against overstimulation.
16 Antipsychotic treatments are often used for rapid treatment of behavioral manifestations of mania, but their effectiveness compared with vigorous treatment with anticonvulsants or combination mood-stabilizer regimens is not established. 17 Combinations of low doses of antipsychotic and benzodiazepine treatments may produce synergistic effects, with resultant lower dose requirements for each drug. In order to effectively treat aggressive behavior in manic episodes, it is necessary to resolve the underlying manic episode. 20 Vigorous early use of mood stabilizers is therefore a vital measure in the resolution of behavioral problems in patients with manic episodes. In general, when an antimanic treatment is ineffective for mania, it is also ineffective for associated aggressive behavior.