BIPOLAR DISORDERBIPOLAR DISORDERThe management of bipolar The management of bipolar disorder in adults, children disorder in adults, children and adolescents, in primary and adolescents, in primary

and secondary careand secondary care

National Institute for Health National Institute for Health and Clinical Excellence (NICE) and Clinical Excellence (NICE)

July 2006July 2006

General guidance for General guidance for psychology:psychology:Working with patients and Working with patients and familiesfamilies• Collaborative relationshipsCollaborative relationships

• Advise on self-monitoring, lifestyle, Advise on self-monitoring, lifestyle, copingcoping

• Advance directivesAdvance directives

• Consider impact on relationships, Consider impact on relationships, parenting; carerparenting; carer’’s needss needs

• AccessibilityAccessibility

General guidance for General guidance for psychology:psychology:Specific groups of patientsSpecific groups of patients• Coincidence of learning disability, Coincidence of learning disability,

personality difficulty: offer same personality difficulty: offer same care for bipolar disordercare for bipolar disorder

• Coincidence of substance misuse: Coincidence of substance misuse: psychosocial interventionpsychosocial intervention

General guidance for General guidance for psychology:psychology:Recognition and treatment Recognition and treatment pathwaypathway• Refer urgently for acute mania, severe Refer urgently for acute mania, severe

depressiondepression• Refer promptly for hypomaniaRefer promptly for hypomania• Consider review if functioning declines Consider review if functioning declines

or response to treatment is pooror response to treatment is poor• Risk assessment, crisis plan with Risk assessment, crisis plan with

triggerstriggers• Treat as severe mental illness; offer Treat as severe mental illness; offer

specialist services accordinglyspecialist services accordingly

General guidance for General guidance for psychology:psychology:Healthy lifestyle, relapse Healthy lifestyle, relapse preventionprevention• Advice on sleep and daily routineAdvice on sleep and daily routine

• Risks of shift work, long hours, flightsRisks of shift work, long hours, flights

• Methods of self-monitoringMethods of self-monitoring

• Extra support after difficult life Extra support after difficult life eventsevents

• Collaborative relapse prevention Collaborative relapse prevention strategystrategy

Specific guidance for Specific guidance for psychology:psychology:Symptom clustersSymptom clusters• Depression: 16-20 sessions CBT for Depression: 16-20 sessions CBT for

chronic/recurrent depressive chronic/recurrent depressive symptoms (Use CBT in preference to symptoms (Use CBT in preference to antidepressants in pregnancy-antidepressants in pregnancy-planning women)planning women)

• Anxiety: Focussed psychological Anxiety: Focussed psychological treatmenttreatment

Specific guidance for Specific guidance for psychology:psychology:Post-acute episode--individualPost-acute episode--individual• Consider individual structured Consider individual structured

psychological interventions, such as psychological interventions, such as CBTCBT

• 16 sessions over 6-9 months16 sessions over 6-9 months– PsychoeducationPsychoeducation– Relapse preventionRelapse prevention– Enhance general copingEnhance general coping– Delivered by those familiar with bipolar Delivered by those familiar with bipolar

patientspatients

Specific guidance for Specific guidance for psychology:psychology:Post-acute episode—family, Post-acute episode—family, psychosocial interventionpsychosocial intervention• Consider family intervention, 6-9 Consider family intervention, 6-9

monthsmonths– PsychoeducationPsychoeducation– Improved communicationImproved communication– Problem solvingProblem solving

• Befriending schemesBefriending schemes

Workshop—Case vignettesWorkshop—Case vignettes

• 3 questions: Each group can ask 3 3 questions: Each group can ask 3 questions to contribute to their questions to contribute to their understanding of the caseunderstanding of the case

• Consider the risksConsider the risks

• Develop a formulationDevelop a formulation

• Accordingly, develop a therapeutic Accordingly, develop a therapeutic care plancare plan