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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

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…

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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…

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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…

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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

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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,…

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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

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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.

Service provision in primary and secondary care…

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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…

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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…


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