Ultra-Rapid, Unexpected, and Full Remission of Manic Episode after Treatment with Haloperidol High Doses – 2 Case Reports

Abstract

Bipolar disorder is a psychiatric condition that can develop severe manic episodes which can be life threatening for patient or others and therefore rapid intervention is required to prevent this. Antipsychotic treatment with FGAs (first generation antipsychotics) is still frequently used for quick sedative effect as well as for the improvement of manic symptoms. Management of agitation in patients with psychiatric disorders is a major problem in acute psychiatric settings with insufficient personnel, situation which is frequent in Romania and other East European countries. FGAs (first generation antipsychotics) and BDZ (benzodiazepine), especially as intramuscular formulation, alone or in combination, have been the treatment choice for extreme agitation and aggression all over the world. Haloperidol is still used to treat schizophrenia and acute psychosis as well as agitation, extreme aggression and manic episode. It is known that common adverse effects include extrapyramidal reactions, restlessness, neuroleptic malignant syndrome, and tremor. High doses of haloperidol are administered to patients when RT (rapid tranquilization) is needed. We present two cases of unusual, unexpected, ultrafast and full remission of a manic episode after treatment with haloperidol high doses.