BIPOLAR DISORDER The management of bipolar disorder in adults, children and adolescents, in primary and secondary care National Institute for Health and Clinical Excellence (NICE) July 2006

General guidance for psychology: Working with patients and families Collaborative relationships Collaborative relationships Advise on self-monitoring, lifestyle, coping Advise on self-monitoring, lifestyle, coping Advance directives Advance directives Consider impact on relationships, parenting; carer ’ s needs Consider impact on relationships, parenting; carer ’ s needs Accessibility Accessibility

General guidance for psychology: Specific groups of patients Coincidence of learning disability, personality difficulty: offer same care for bipolar disorder Coincidence of learning disability, personality difficulty: offer same care for bipolar disorder Coincidence of substance misuse: psychosocial intervention Coincidence of substance misuse: psychosocial intervention

General guidance for psychology: Recognition and treatment pathway Refer urgently for acute mania, severe depression Refer urgently for acute mania, severe depression Refer promptly for hypomania Refer promptly for hypomania Consider review if functioning declines or response to treatment is poor Consider review if functioning declines or response to treatment is poor Risk assessment, crisis plan with triggers Risk assessment, crisis plan with triggers Treat as severe mental illness; offer specialist services accordingly Treat as severe mental illness; offer specialist services accordingly

General guidance for psychology: Healthy lifestyle, relapse prevention Advice on sleep and daily routine Advice on sleep and daily routine Risks of shift work, long hours, flights Risks of shift work, long hours, flights Methods of self-monitoring Methods of self-monitoring Extra support after difficult life events Extra support after difficult life events Collaborative relapse prevention strategy Collaborative relapse prevention strategy

Specific guidance for psychology: Symptom clusters Depression: sessions CBT for chronic/recurrent depressive symptoms (Use CBT in preference to antidepressants in pregnancy-planning women) Depression: sessions CBT for chronic/recurrent depressive symptoms (Use CBT in preference to antidepressants in pregnancy-planning women) Anxiety: Focussed psychological treatment Anxiety: Focussed psychological treatment

Specific guidance for psychology: Post-acute episode--individual Consider individual structured psychological interventions, such as CBT Consider individual structured psychological interventions, such as CBT 16 sessions over 6-9 months 16 sessions over 6-9 months –Psychoeducation –Relapse prevention –Enhance general coping –Delivered by those familiar with bipolar patients

Specific guidance for psychology: Post-acute episode—family, psychosocial intervention Consider family intervention, 6-9 months Consider family intervention, 6-9 months –Psychoeducation –Improved communication –Problem solving Befriending schemes Befriending schemes

Workshop—Case vignettes 3 questions: Each group can ask 3 questions to contribute to their understanding of the case 3 questions: Each group can ask 3 questions to contribute to their understanding of the case Consider the risks Consider the risks Develop a formulation Develop a formulation Accordingly, develop a therapeutic care plan Accordingly, develop a therapeutic care plan