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Bipolar disorder - Coggle Diagram

- - - - Refer all people with suspected bipolar disorder to specialist mental health service to confirm the diagnosis, treat the acute episodes and establish a care plan
      - Assess the severity of depression and risk of suicide. Determine the risk of harm to others
      - When determining the required urgency of admission/referral, also consider other potentially harmful consequences of poor judgment and associated actions during an acute episode, that may adversely effect the person's employment, personal relationships, and finances, and also the risks posed by driving, sexual activity, and alcohol/drug use.
      - In confirmed bipolar disorder - prescribe medication initiated in secondary care and undertake any monitoring required, ensure person is offered appropriate psychological interventions that have either been developed specifically for bipolar disorder, monitor mood and follow crisis plans, review the person's physical health, mental health and medication at least annually and ensure the person/carer is informed about support available to them.
      - If the person needs to be admitted to hospital, every attempt should be made to persuade them to go voluntarily. If the person refuses to go to hospital, compulsory admission may be necessary if the person: requires assessment and/or treatment in a hospital; needs to be admitted in the interests of their own health or safety; or Compulsory admission may be arranged under sections 2, 3, or 4 of the Mental Health Act.
      - While waiting specialist assessment do not start antipsychotic medication unless on a consultant advice, consider tapering antidepressant medication on specialist advice if mania develops, and advice the person to stop driving during acute illness and that their insurance may not be valid.
      - If a person with bipolar disorder is being managed solely in primary care, re‑refer them to secondary care if: poor/partial response to treatment, adherance is poor, functioning declines significantly, develop intolerable/medically important side effects of medication, comorbid alcohol or drug misuse is suspected, the person is considering stopping taking their medication or a women is pregnant/planning pregnancy.
- - - - Ask about symptoms that could be due to adverse effects of medication.
      - Assess for early warning signs of relapse. Give advice on avoiding relapse.
      - Ensure that there are arrangements in place for monitoring of lithium, valproate, and antipsychotics (if applicable).
      - Assess symptom control by asking about symptoms of mania, hypomania, or depression, and seek specialist advice regarding ongoing management if needed
      - Ask about alcohol intake and substance misuse, and encourage people who smoke to stop. Ask about the person's diet, and level of physical activity, check the person's weight, and measure their waist circumference.
      - If being managed in primary care assess mental and physical health at least annually or assess mental health more regularly if the person/carer expresses concern, there is sleep disturbance or significant life events.
      - Measure the person's pulse and blood pressure, and assess and manage the person's cardiovascular risk. Blood tests: Fasting glucose, HbA1c, lipid profile, U&Es, FBC, LFTs, TFTs. Calcium level.
      - Manage any health concerns appropriately. Send a copy of results to care co-ordinator. If the person does not attend a review appointment (within 14 days) and unable to make contact, inform care co-ordinator.