{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T05:17:09Z","timestamp":1777785429897,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T00:00:00Z","timestamp":1587945600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100014434","name":"irving medical center, columbia university","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014434","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Am Psychiatr Nurses Assoc"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>(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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>Psychiatric providers were evaluated for knowledge enhancement through a pre-\/post\u2013educational 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Rapid mood stabilization may be achieved by using a combination therapy\u2013based mania protocol. Educational sessions can enhance psychiatric provider knowledge with regard to evidence-based treatments for mania.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1078390320916543","type":"journal-article","created":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T02:32:38Z","timestamp":1588041158000},"page":"496-501","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Mania Pathway Protocol: An Application of Evidence-Based Interventions for the Treatment of Acute Mania on an Inpatient Psychiatric Unit"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7961-1618","authenticated-orcid":false,"given":"Avishay A.","family":"Adri","sequence":"first","affiliation":[{"name":"Avishay A. Adri, DNP, PMHNP-BC, Columbia University Medical Center, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,4,27]]},"reference":[{"key":"bibr1-1078390320916543","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https:\/\/doi.org\/10.1176\/appi.books.9780890425596","DOI":"10.1176\/appi.books.9780890425596"},{"key":"bibr2-1078390320916543","doi-asserted-by":"crossref","unstructured":"Cloutier M., Greene M., Guerin A., Touya M., Wu E. (2018). The economic burden of bipolar I disorder in the United States in 2015. Journal of Affective Disorders, 226, 45-51. https:\/\/doi.org\/10.1016\/j.jad.2017.09.011","DOI":"10.1016\/j.jad.2017.09.011"},{"key":"bibr3-1078390320916543","doi-asserted-by":"crossref","unstructured":"Earley W., Durgam S., Lu K., Ruth A., N\u00e9meth G., Laszlovszky I., Yatham L. N. (2018). Clinically relevant response and remission outcomes in cariprazine-treated patients with bipolar I disorder. Journal of Affective Disorders, 226, 239-244. https:\/\/doi.org\/10.1016\/j.jad.2017.09.040","DOI":"10.1016\/j.jad.2017.09.040"},{"key":"bibr4-1078390320916543","doi-asserted-by":"crossref","unstructured":"Forte A., Baldessarini R. J., Tondo L., V\u00e1zquez G. H., Pompili M., Girardi P. (2015). Long-term morbidity in bipolar-I, bipolar-II, and unipolar major depressive disorders. Journal of Affective Disorders, 178, 71-78. https:\/\/doi.org\/10.1016\/j.jad.2015.02.011","DOI":"10.1016\/j.jad.2015.02.011"},{"key":"bibr5-1078390320916543","doi-asserted-by":"crossref","unstructured":"Geoffroy P. A., Etain B., Henry C., Bellivier F. (2012). Combination therapy for manic phases: A critical review of a common practice. CNS Neuroscience Therapy, 18(12), 957-964. https:\/\/doi.org\/10.1111\/cns.12017","DOI":"10.1111\/cns.12017"},{"key":"bibr6-1078390320916543","doi-asserted-by":"crossref","unstructured":"Glue P., Herbison P. (2015). Comparative efficacy and acceptability of combined antipsychotics and mood stabilizers versus individual drug classes for acute mania: Network meta-analysis. Australian & New Zealand Journal of Psychiatry, 49(12), 1215-1220. https:\/\/doi.org\/10.1177\/0004867415614109","DOI":"10.1177\/0004867415614109"},{"key":"bibr7-1078390320916543","doi-asserted-by":"crossref","unstructured":"Grande I., Vieta E. (2015). Pharmacotherapy of acute mania: Monotherapy or combination therapy with mood stabilizers and antipsychotics? CNS Drugs, 29(3), 221-227. https:\/\/doi.org\/10.1007\/s40263-015-0235-1","DOI":"10.1007\/s40263-015-0235-1"},{"key":"bibr8-1078390320916543","volume-title":"Nursing research: Reading, using, and creating evidence","author":"Houser J","year":"2012","edition":"2"},{"key":"bibr9-1078390320916543","unstructured":"Lee A. M. R., Galynker I. I. (2014). 7 Steps to prevent and manage violence in bipolar patients. Psychiatric Times, 31(11), 1-9. https:\/\/www.psychiatrictimes.com\/bipolar-disorder\/7-steps-prevent-and-manage-violence-bipolar-patients"},{"key":"bibr10-1078390320916543","doi-asserted-by":"crossref","unstructured":"Lukasiewicz M., Gerard S., Besnard A., Falissard B., Perrin E., Sapin H., Tohen M., Reed C., Azorin J. & the members of the Emblem Study Group. (2013). Young Mania Rating Scale: How to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort. International Journal of Methods in Psychiatric Research, 22(1), 46-58. https:\/\/doi.org\/10.1002\/mpr.1379","DOI":"10.1002\/mpr.1379"},{"key":"bibr11-1078390320916543","doi-asserted-by":"crossref","unstructured":"Nielssen O. B., Malhi G. S., Large M. M. (2012). Mania, homicide and severe violence. Australian & New Zealand Journal of Psychiatry, 46(4), 357-363. https:\/\/doi.org\/10.1177\/0004867411433217","DOI":"10.1177\/0004867411433217"},{"key":"bibr12-1078390320916543","doi-asserted-by":"crossref","unstructured":"Ogawa Y., Tajika A., Takeshima N., Hayasaka Y., Furukawa T. A. (2014). Mood stabilizers and antipsychotics for acute mania: A systematic review and meta-analysis of combination\/augmentation therapy versus monotherapy. CNS Drugs, 28(11), 989-1003. https:\/\/doi.org\/10.1007\/s40263-014-0197-8","DOI":"10.1007\/s40263-014-0197-8"},{"key":"bibr13-1078390320916543","doi-asserted-by":"crossref","unstructured":"Oostervink F., Nolen W. A., Kok R. M. (2015). Two years\u2019 outcome of acute mania in bipolar disorder: Different effects of age and age of onset. International Journal of Geriatric Psychiatry, 30(2), 201-209. https:\/\/doi.org\/10.1002\/gps.4128","DOI":"10.1002\/gps.4128"},{"issue":"6","key":"bibr14-1078390320916543","first-page":"335","volume":"21","author":"Pestka E. L.","year":"2012","journal-title":"MEDSURG Nursing"},{"key":"bibr15-1078390320916543","doi-asserted-by":"crossref","unstructured":"Scherk H., Pajonk F. G., Leucht S. (2009). Review: Adding second generation antipsychotics to mood stabilisers reduces acute mania symptoms. 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