The management of acute mania during pregnancy poses a complex clinical task, necessitating careful consideration of treatment options and demanding a delicate balance between the risks associated with medication use and the adverse impacts of untreated severe mental illness on the fetus. Medication nonadherence stands out as a significant factor contributing to relapse, with rates potentially reaching 40%. The pharmacokinetic profile of long-acting injectable (LAI) risperidone contrasts with that of oral risperidone, characterized by a gradual and consistent release from the depot, mitigating fluctuations between peak and trough concentrations. Clinically, this sustained plasma profile of LAI risperidone has been linked to a reduction in adverse events, such as extrapyramidal side effects, metabolic syndrome, and hyperprolactinemia. Numerous studies have indicated that LAI antipsychotic therapy correlates with reduced mortality rates and decreased number of hospitalizations. This case report illustrates the effective management of acute mania in a pregnant 32-year-old through the utilization of LAI risperidone. This case underscores the significance of individualized treatment strategies and emphasizes the potential utility of LAI antipsychotics as a viable therapeutic option for managing acute mania in pregnancy. Further research is warranted to delineate the long-term outcomes and safety profile of LAI antipsychotics in this population.
Keywords: acute mania; lai; long-acting injectables; medication nonadherence; peripartum psychosis; pregnancy; substance use obstetrics.
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