Aripiprazole-Associated Mania and Hypomania

Risk Factors and Clinical Presentation

Behavioral activation, characterized by motor restlessness, insomnia, impulsiveness, talkativeness, disinhibited behavior, and aggression, typically occurs early in treatment, with dose increases, and resolves quickly after dose reduction or discontinuation, according to the American Academy of Child and Adolescent Psychiatry 1
Mania or hypomania may appear later in the treatment course, persist despite dose reduction, and require more active pharmacological intervention, as noted by the American Academy of Child and Adolescent Psychiatry 1
The American Academy of Child and Adolescent Psychiatry recommends distinguishing between early behavioral activation and true mania, which persists and worsens, when monitoring patients on aripiprazole 1

Patients with comorbid ADHD should be monitored closely, as stimulants should not be used in patients with manic episodes with psychosis, according to guidelines from the American Academy of Child and Adolescent Psychiatry 2
Akathisia, which can be mistaken for agitation, can be managed with beta-blockers or benzodiazepines rather than discontinuation of aripiprazole, as suggested by Praxis Medical Insights, but a more suitable source is preferred, however, this is the only available citation for this fact 3