The Mania Pathway Protocol: An Application of Evidence-Based Interventions for the Treatment of Acute Mania on an Inpatient Psychiatric Unit

Abstract

Introduction: Acute manic episodes are a psychiatric emergency related to violence and poor patient outcomes. Combination psychotropic therapy utilizing a mood stabilizer and an atypical antipsychotic has been shown to be more efficacious for treating acute mania compared to monotherapy with either mood stabilizers or antipsychotics alone. This quality improvement project implemented evidence-based interventions for treating acute mania. The mania pathway protocol was created as a comprehensive clinical guide for guiding mania treatment. The protocol was implemented on an inpatient psychiatric unit for patients with mania diagnoses including manic/mixed episodes of bipolar disorder or schizoaffective disorder. Aims: (1) to improve the treatment of mania by using evidence-based interventions for rapid mood stabilization and (2) to educate psychiatric providers on up-to-date interventions for treating acute manic states. Method: Psychiatric providers were evaluated for knowledge enhancement through a pre-/post–educational session quiz. A retrospective chart review was used for data collection for patients treated with the mania pathway protocol. The retrospective chart review spanned 8 weeks post project implementation. Young Mania Rating Scale (YMRS) scores were analyzed to measure the effect on mania severity. Results: The percentage decrease in mean Young Mania Rating Scale scores from admission to the fifth day of hospitalization was 61%. All psychiatric providers proved knowledge attainment by scoring 100% on the postintervention quiz. Conclusions: Rapid mood stabilization may be achieved by using a combination therapy–based mania protocol. Educational sessions can enhance psychiatric provider knowledge with regard to evidence-based treatments for mania.