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Bipolar disorder - Management
What routine follow up is needed in primary care?

  • To ensure follow up, include all people with bipolar disorder on a register of serious mental illness.
  • Arrange to review all people with bipolar disorder at least annually.
    • Review more frequently:
      • People managed solely in primary care.
      • If there is sleep disturbance.
      • After significant life events, such as loss of a job or bereavement.
  • Attempt to make contact (within 14 days) with people who do not attend. Consider informing their key worker (who may be their psychiatrist, community psychiatric nurse, or social worker).
  • At the review appointment(s):
Clarification / Additional information
Basis for recommendation
  • These recommendations are based on 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] and the Quality and outcomes framework guidance for GMS contract 2008/09 [BMA and NHS Employers, 2008].
    • CKS found no guidance relating to the frequency of review of people with bipolar disorder managed solely in primary care:
    • More frequent review is recommended by NICE if there is sleep disturbance or after stressful life events on the basis that both may trigger an episode, and sleep disturbance is an early symptom of a depressive or hypomanic/manic episode [National Collaborating Centre for Mental Health, 2006; NICE, 2006].

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