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Bipolar disorder - Management
Overview of management
- New or suspected bipolar disorder:
- Refer all people with new or suspected bipolar disorder for a specialist mental health assessment.
- Determine the urgency of any referral by assessing the risks to the individual and others.
- Known bipolar disorder (depressive episode):
- For people with severe depression, refer urgently. Admission may be required if the person is a danger to themselves or to others.
- For people with moderate depression and no increase in the degree of risk to self or others, arrange a prompt specialist mental health review.
- For people with mild depression, an initial period of watchful waiting may be appropriate. Seek specialist mental health advice and consider an early specialist mental health review if the person's previous episodes of mild depression have developed into chronic or more severe depression, or a more severe depression is otherwise likely.
- Known bipolar disorder (hypomanic or manic episode):
- Refer urgently all people in a manic episode for specialist mental health assessment. Admission may be required.
- Refer all people in a hypomanic episode for a prompt specialist mental health review.
- Known bipolar disorder (mixed episode):
- Refer urgently to secondary care.
- Women of childbearing age with bipolar disorder:
- Refer to a psychiatrist all women who are planning a pregnancy, have an unplanned pregnancy, have a depressive episode, or experience mania or hypomania.
- Do not prescribe valproate to women of childbearing age.
- Routine follow up:
- Include all people with bipolar disorder on a register of serious mental illness and review at least annually; more frequently if solely managed in primary care.
- At the review appointment(s):
- Whilst awaiting referral or admission for anyone with suspected or known bipolar disorder, alter or initiate drug treatment only on specialist advice.
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