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Bipolar disorder - Management
What should I do at a physical health review?
Clarification / Additional information
- Annual review may also be an opportunity to:
- Ask about substance misuse.
- Assess for chronic obstructive pulmonary disease and asthma, as there are high rates in people with bipolar disorder.
- Check that women are receiving regular cervical screening, if appropriate.
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; National Collaborating Centre for Mental Health, 2006], Quality and outcomes framework (QOF) guidance for GMS contract 2008/09 [BMA and NHS Employers, 2008], and a review article on the role of primary care in bipolar disorder [Tylee and Goodwin, 2006]:
- People with bipolar disorder have high rates of physical morbidity and double the mortality rate from cardiovascular causes compared with the general population [National Collaborating Centre for Mental Health, 2006; BMA and NHS Employers, 2008].
- People with bipolar disorder are at increased risk of diabetes (particularly if they are taking newer atypical antipsychotic drugs such as olanzapine) and have higher rates of hypertension, dyslipidaemia, and obesity than the general population [National Collaborating Centre for Mental Health, 2006; Tylee and Goodwin, 2006; BMA and NHS Employers, 2008].
- The recommendation to ask about substance abuse is based on a review article [Tylee and Goodwin, 2006].
- People with bipolar disorder also have higher rates of asthma and chronic obstructive pulmonary disease [Tylee and Goodwin, 2006].
- The recommendation to check that women are receiving regular cervical screening is from the QOF guidance [BMA and NHS Employers, 2008].
- Information about the effect of smoking on olanzapine and clozapine reflects recent advice from the Medicines and Healthcare products Regulatory Agency (MHRA) [MHRA, 2009b].
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