bipolar disorder quick

bipolar disorder quick

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  • Created on: 29-06-10 17:55
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Quick reference guide
Issue date: July 2006
Bipolar disorder
The management of bipolar disorder in adults, children
and adolescents, in primary and secondary care
NICE clinical guideline 38
Developed by the National Collaborating Centre for Mental Health

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Bipolar disorder Contents
Contents
Key priorities for implementation 3
Using this quick reference guide 4
General principles 5
Assessment, recognition and diagnosis 6
Treatment settings and pathways to care 8
Managing acute episodes 10
Long-term management of bipolar disorder 16
Managing bipolar disorder in pregnant women 24
Children and adolescents with bipolar disorder 27
Implementation 31
Further information 31
Patient-centred care
Treatment and care should take into account patients' individual needs and preferences.…read more

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Bipolar disorder Key priorities for implementation
Key priorities for implementation
Treating bipolar disorder with drugs
G Valproate should not be prescribed routinely for women of child-bearing potential. If no effective
alternative to valproate can be identified, adequate contraception should be used, and the risks of
taking valproate during pregnancy should be explained.
G Lithium, olanzapine or valproate* should be considered for long-term treatment of bipolar
disorder.…read more

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Bipolar disorder Key priorities for implementation
Key priorities for implementation continued
Monitoring physical health
G People with bipolar disorder should have an annual physical health review, normally in primary
care, to ensure that the following are assessed each year:
­ lipid levels, including cholesterol in all patients over 40 even if there is no other indication of risk
­ plasma glucose levels
­ weight
­ smoking status and alcohol use
­ blood pressure.…read more

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Bipolar disorder General principles
General principles
Working with patients and their families
G Establish and maintain collaborative relationships with patients, families and carers (within the bounds
of confidentiality):
­ respect the patient's knowledge and experience of the illness
­ encourage patients to involve their families and carers if appropriate
­ give patients, families and carers information (including information on medication) at every stage
of assessment, diagnosis and treatment
­ encourage patients, family and carers to join self-help and support groups.…read more

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Assessment, recognition
Bipolar disorder and diagnosis
Assessment, recognition and diagnosis
Bipolar disorder in primary care
New or suspected presentations of bipolar disorder
G Refer urgently patients with mania or severe depression who are a danger to themselves or
other people.
G Refer for assessment and development of a care plan, patients with either:
­ periods of overactive, disinhibited behaviour lasting at least 4 days, with or without periods of
depression, or
­ three or more depressive episodes and a history of overactive, disinhibited behaviour.…read more

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Assessment, recognition
Bipolar disorder and diagnosis
G More pronounced psychotic symptoms, increased suicidal ideation, drug misuse, or more disturbed
behaviour may be a late presentation of bipolar disorder and not of a schizophrenia-spectrum disorder,
particularly in patients from black and minority ethnic groups, who may have difficulty accessing
services.
G Drug or alcohol misuse may induce manic-like symptoms ­ in inpatient settings, wait 7 days before
confirming bipolar disorder if there is evidence of misuse.…read more

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Treatment setting and pathways
Bipolar disorder to care
Treatment setting and pathways to care
Continuity of care for people with bipolar disorder
G Where possible, people with bipolar disorder ­ including those with sub-threshold symptoms ­
should see the same healthcare professionals regularly.…read more

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Treatment setting and pathways
Bipolar disorder to care
Crisis resolution and home treatment teams
G Consider as a way of:
­ managing crises at home or in the community
­ supporting early discharge from hospital.
G Should give particular attention to managing risk, monitoring behavioural disturbance, and the
burden on family and carers.
Early intervention services for people with psychosis
G Should provide expertise in diagnosis, and pharmacological, psychological, social, occupational and
educational interventions.…read more

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Bipolar disorder Managing acute episodes
Managing acute episodes
General recommendations
G Decide treatment plans in collaboration with patients, considering the outcome of previous treatment(s)
and the patient's preference.
G With all women of child-bearing potential, discuss contraception and the risks of pregnancy (including
relapse, damage to the fetus and risks associated with stopping and changing medication). Encourage
women to discuss pregnancy plans with their doctor (see pages 24­26 for more information).…read more

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