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Bipolar disorder - Management
How do I assess risks in a person with a manic or hypomanic episode?
- Risk assessment determines the urgency of referral to specialist mental health services.
- Consider these risks of harm to the individual as a consequence of hypomanic or manic symptoms:
- Financial ruin arising from overspending.
- Traumatic injuries and accidents.
- Sexually transmitted infections and unplanned pregnancy arising from disinhibition and increased libido.
- Damage to reputation, income and occupation, and relationships.
- Self-neglect, exhaustion, and dehydration.
- Exploitation by others.
- Alcohol and substance misuse.
- Consider the risks of harm to others, including:
- To family, in particular children and other dependents, from:
- Neglect.
- Paranoid delusions.
- Grandiosity, overspending, poor judgement, and erratic or chaotic behaviour during a manic episode.
- Rarely, violence and aggression (particularly if there is a personal history of violent behaviour).
- To the public, from:
- Rarely, violence and aggression.
- Injuries arising from poor judgement or impulsive behaviour (e.g. whilst driving).
Basis for recommendation
- Risk assessment determines the urgency of referral to specialist mental health services.
- This statement is based on two recommendations in the National Institute for Health and Clinical Excellence (NICE) guideline Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care [NICE, 2006]:
- 'Do a risk assessment when bipolar is first diagnosed, or there is a significant change in mental state or personal circumstances.'
- 'Primary care clinicians should urgently refer patients with mania or severe depression who are a danger to themselves or other people, to specialist mental health services.'
- Consider the risks of harm to the individual as a consequence of hypomanic or manic symptoms and consider the risks of harm to others:
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