When and how do you taper antipsychotics after a resolved episode of bipolar mania with psychotic features?

At times, I have worked with patients to taper antipsychotics even in the absence of current side effects due to their concerns about long-term side effects (dyslipidemia/weight gain and TD, mostly). This is most often my strategy when folks are ambivalent about medications in general and don't like the sound of adding other medicines to address the side effects of antipsychotics (e.g., metformin, cogentin, etc.).

I think the decision to taper also depends on what their other medications are. If a patient is on antipsychotic monotherapy, I am more reluctant to taper it than if they are on a mood stabilizer + antipsychotic combination, particularly if they are within the first three months after their most recent episode. Also, it is importa...

I agree with the answers here. If no significant side effects arise from the atypical, I prefer to continue it for at least 6 months. If the patient is very stable, I might consider a slight decrease at that point and aim to extend it to a year if possible.

If there are metabolic side effects, it may be possible to switch to a more weight-neutral atypical once they are mentally improved.

I often use the argument that mania (and possibly subsequent severe depression) is VERY disruptive to one's life. Inpatient stays are rough to go through for patients and loved ones, so I want to try to avoid relapses caused by cutting down/tapering off too fast.

It depends on whether there is a reason to taper and discontinue the anti-psychotic medication. In most cases, it will provide ongoing mood stabilization so unless there are unwanted side effects, it would make sense to continue it, perhaps reducing the dose once the manic symptoms have resolved.