Medication algorithm for severe mania in bipolar I disorder*

* Determining the regimen requires an initial psychiatric evaluation to establish the diagnosis of bipolar I disorder and any comorbidities (eg, renal or hepatic disorders) that can affect treatment choices. Severe mania is characterized by suicidal or homicidal ideation or behavior, aggressiveness, or psychosis, and is generally an indication for hospitalization. Full details of choosing a medication regimen for severe mania are discussed in the UpToDate topic on treating acute mania and hypomania.