Expert: Ivan Goldberg, M.D. - 8/12/2010

Question
Should a person diagonosed with Bipolar I with psychotic features be kept on antipychotics indefinetly. My daughter had her first manic episode a year ago...then taken off Abilly and just maintained on lithium a month later. Three months after that had a second manic episode with pyshosis four months later. Now is on litthium and Abillgy for maintenance. I am worried about the serious possible side effects of long-term treatment of antipsychotics, and want to know if there is another way to go in treating this kind of bipolar.

Answer
Hi Jan . . .

The first problem is one of diagnosis. Many people diagnosed with a psychotic form of Bipolar-I Disorder are misdiagnosed and the correct diagnosis is Schizo-Affective Disorder. While it is often a serious mistake for those with Bipolar-I to be kept on long-term antipsychotic medications, it unfortunately often is necessary for people with Schizo-Affective Disorder to take antipsychotic medications chronically.

Because of the very real possibilities of tardive dyskinesia, neuroleptic malignant syndrome, obesity and diabetes, long term antipsychotic medication should be avoided whenever possible.

Best regards . . .

Ivan
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