Excerpt

This guideline has been developed to advise on the treatment and management of bipolar disorder. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, patients and guideline methodologists after careful consideration of the best available evidence. It is intended that the guidelines will be useful to clinicians and service commissioners in providing and planning high quality care for those with bipolar disorder while also emphasising the importance of the experience of care for patients and carers.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERSHIP
• ACKNOWLEDGEMENTS
• 1. EXECUTIVE SUMMARY
  • KEY PRIORITIES FOR IMPLEMENTATION
  • 1.1 GENERAL RECOMMENDATIONS FOR THE CARE OF PEOPLE WITH BIPOLAR DISORDER
  • 1.2 THE ASSESSMENT, RECOGNITION AND DIAGNOSIS OF BIPOLAR DISORDER IN ADULTS
  • 1.3 TREATMENT SETTING AND PATHWAYS TO CARE
  • 1.4 THE TREATMENT AND MANAGEMENT OF BIPOLAR DISORDER
  • 1.5 THE LONG-TERM MANAGEMENT OF BIPOLAR DISORDER
  • 1.6 THE PHYSICAL CARE OF PEOPLE WITH BIPOLAR DISORDER
  • 1.7 WOMEN WITH BIPOLAR DISORDER WHO ARE PLANNING A PREGNANCY, PREGNANT OR BREASTFEEDING
  • 1.8 CHILDREN AND ADOLESCENTS WITH BIPOLAR DISORDER
  • 1.9 RESEARCH RECOMMENDATIONS
• 2. INTRODUCTION
  • 2.1 NATIONAL GUIDELINES
  • 2.2 THE NATIONAL BIPOLAR DISORDER GUIDELINE
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1 OVERVIEW
  • 3.2 THE SCOPE
  • 3.3 THE GUIDELINE DEVELOPMENT GROUP
  • 3.4 CLINICAL QUESTIONS
  • 3.5 SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 3.6 HEALTH ECONOMICS REVIEW STRATEGIES
  • 3.7 STAKEHOLDER CONTRIBUTIONS
  • 3.8 VALIDATION OF THIS GUIDELINE
• 4. BIPOLAR DISORDER AND ITS DIAGNOSIS
  • 4.1 THE DISORDER
  • 4.2 INCIDENCE AND PREVALENCE
  • 4.3 AETIOLOGY
  • 4.4 DIAGNOSIS OF ADULTS
  • 4.5 DIAGNOSIS OF CHILDREN AND ADOLESCENTS
  • 4.6 COURSE AND PROGNOSIS
  • 4.7 THE TREATMENT AND MANAGEMENT OF BIPOLAR DISORDER IN THE NHS
  • 4.8 THE ECONOMIC COST OF BIPOLAR DISORDER
• 5. SERVICE USER AND CARER EXPERIENCE OF BIPOLAR DISORDER
  • 5.1 INTRODUCTION
  • 5.2 TESTIMONIES FROM SERVICES USERS
  • 5.3 TESTIMONIES FROM FAMILY MEMBERS/CARERS
  • 5.4 RECOMMENDATIONS
• 6. THE PROCESS OF CARE AND PROVISION OF SERVICES IN THE MANAGEMENT OF BIPOLAR DISORDER – GENERAL CARE
  • 6.1 INTRODUCTION
  • 6.2 OVERVIEW OF CLINICAL EVIDENCE REVIEW
  • 6.3 OVERVIEW OF HEALTH ECONOMICS REVIEW
  • 6.4 COMMUNITY MENTAL HEALTH TEAMS (CMHTs)
  • 6.5 CASE MANAGEMENT AND EFFECTIVE CARE CO-ORDINATION
  • 6.6 CRISIS RESOLUTION AND HOME TREATMENT TEAMS (CRHTTs)
  • 6.7 DAY HOSPITALS
  • 6.8 SERVICES FOR CHILDREN AND ADOLESCENTS
• 7. THE PROCESS OF CARE AND PROVISION OF SERVICES IN THE MANAGEMENT OF BIPOLAR DISORDER – SPECIALIST SERVICES
  • 7.1 INTRODUCTION
  • 7.2 ASSERTIVE COMMUNITY TREATMENT (ACT)/ASSERTIVE OUTREACH TEAMS (AOTs)
  • 7.3 VOCATIONAL REHABILITATION
  • 7.4 EARLY INTERVENTION SERVICES
  • 7.5 ORGANISATIONAL DEVELOPMENTS
  • 7.6 LITHIUM CLINICS
• 8. THE MEDICAL AND PHARMACOLOGICAL MANAGEMENT OF BIPOLAR DISORDER – PART I
  • 8.1 INTRODUCTION
  • 8.2 OVERVIEW OF CLINICAL EVIDENCE REVIEW
  • 8.3 THE PHARMACOLOGICAL TREATMENT OF ACUTE MANIC, HYPOMANIC AND MIXED EPISODES
  • 8.4 ECONOMIC EVIDENCE FOR THE TREATMENT OF ACUTE MANIC EPISODES
  • 8.5 THE PHARMACOLOGICAL TREATMENT OF ACUTE EPISODES IN THE CONTEXT OF RAPID CYCLING
  • 8.6 THE PHARMACOLOGICAL TREATMENT OF ACUTE DEPRESSED EPISODES
  • 8.7 ELECTROCONVULSIVE THERAPY (ECT) (ALL ILLNESS PHASES)
  • 8.8 THE MANAGEMENT OF ACUTE BEHAVIOURAL DISTURBANCE
• 9. THE MEDICAL AND PHARMACOLOGICAL MANAGEMENT OF BIPOLAR DISORDER – PART II
  • 9.1 INTRODUCTION
  • 9.2 THE LONG-TERM PHARMACOLOGICAL MANAGEMENT OF BIPOLAR DISORDER
  • 9.3 HEALTH ECONOMICS EVIDENCE IN THE LONG-TERM PHARMACOLOGICAL TREATMENT OF BIPOLAR DISORDER
  • 9.4 THE LONG-TERM TREATMENT OF BIPOLAR DISORDER – SUMMARY OF CLINICAL AND HEALTH ECONOMICS EVIDENCE
  • 9.5 CLINICAL PRACTICE RECOMMENDATIONS FOR THE LONG-TERM TREATMENT OF BIPOLAR DISORDER
  • 9.6 RESEARCH RECOMMENDATIONS
  • 9.7 THE DISCONTINUATION/WITHDRAWAL OF MEDICATION
  • 9.8 THE PHARMACOLOGICAL MANAGEMENT OF BIPOLAR II DISORDER
  • 9.9 THE PHARMACOLOGICAL MANAGEMENT OF WOMEN OF CHILD-BEARING POTENTIAL: BEFORE, DURING, AND AFTER PREGNANCY
• 10. PSYCHOLOGICAL THERAPIES IN THE TREATMENT OF BIPOLAR DISORDER
  • 10.1 INTRODUCTION: HISTORY OF TREATMENT FOR BIPOLAR DISORDER
  • 10.2 PRINCIPLES OF PSYCHOLOGICAL TREATMENT
  • 10.3 THE EARLY WARNING APPROACH
  • 10.4 OVERVIEW OF CLINICAL REVIEW
  • 10.5 OVERVIEW OF HEALTH ECONOMICS REVIEW
  • 10.6 FAMILY INTERVENTIONS
  • 10.7 PSYCHOEDUCATION
  • 10.8 COGNITIVE BEHAVIOURAL THERAPY (CBT)
  • 10.9 PSYCHOLOGICAL THERAPY FOR PEOPLE WITH COMORBID SUBSTANCE USE DISORDER
  • 10.10 INTERPERSONAL AND SOCIAL RHYTHM THERAPY (IPSRT)
  • 10.11 PSYCHOLOGICAL THERAPY FOR MEDICATION ADHERENCE
  • 10.12 Clinical summary
  • 10.13 SUMMARY OF ECONOMIC EVIDENCE
  • 10.14 PSYCHOLOGICAL TREATMENTS FOR CHILDREN AND ADOLESCENTS
  • 10.15 CLINICAL RECOMMENDATIONS
• 11. LIVING WITH BIPOLAR DISORDER: INTERVENTIONS AND LIFESTYLE ADVICE
  • 11.1 INTRODUCTION
  • 11.2 THE PREVENTION AND MANAGEMENT OF WEIGHT GAIN
  • 11.3 EXERCISE IN THE TREATMENT OF DEPRESSION IN PEOPLE WITH BIPOLAR DISORDER
  • 11.4 PSYCHOEDUCATION AND INFORMATION GIVING
  • 11.5 MANAGING DAILY LIFE
  • 11.6 SOCIAL SUPPORT
  • 11.7 ADDITIONAL CLINICAL PRACTICE RECOMMENDATION
• 12. APPENDICES
  • APPENDIX 1 SCOPE FOR THE DEVELOPMENT OF A CLINICAL GUIDELINE ON THE MANAGEMENT OF BIPOLAR DISORDER
  • APPENDIX 2 ADVISORS TO THE GUIDELINE DEVELOPMENT GROUP
  • APPENDIX 3 STAKEHOLDERS WHO RESPONDED TO EARLY REQUESTS FOR EVIDENCE
  • APPENDIX 4 STAKEHOLDERS AND EXPERTS WHO RESPONDED TO THE FIRST CONSULTATION DRAFT OF THE GUIDELINE
  • APPENDIX 5 CLINICAL QUESTIONS
  • APPENDIX 6 SEARCH STRATEGIES FOR THE IDENTIFICATION OF STUDIES
  • APPENDIX 7 CLINICAL STUDY ELIGIBILITY CHECKLIST
  • APPENDIX 8 RCT METHODOLOGICAL QUALITY CHECKLIST
  • APPENDIX 9 CLINICAL STUDY DATA EXTRACTION FORMS
  • APPENDIX 10 FORMULAE FOR CALCULATING STANDARD DEVIATIONS
  • APPENDIX 11 OUTCOMES, RATING SCALES AND DIAGNOSTIC SCALES
  • APPENDIX 12 QUALITY CHECKLIST FOR HEALTH ECONOMICS STUDIES
  • APPENDIX 13 DATA EXTRACTION FORM FOR HEALTH ECONOMICS STUDIES
  • APPENDIX 14 HEALTH ECONOMICS EVIDENCE TABLES
  • APPENDIX 15 COST ESTIMATES OF MAINTENANCE AND ACUTE TREATMENT OF PATIENTS WITH BIPOLAR I DISORDER UTILISED IN THE ECONOMIC MODEL
  • APPENDIX 16 ESTIMATION OF ONE-YEAR ABSOLUTE RELAPSE RATES OF MANIC AND DEPRESSIVE EPISODES ASSOCIATED WITH LONG-TERM PLACEBO TREATMENT, FOR USE IN THE ECONOMIC MODEL OF MAINTENANCE PHARMACOLOGICAL TREATMENT OF PATIENTS WITH BIPOLAR I DISORDER
  • APPENDIX 17 ECONOMIC EVALUATION OF PHARMACOLOGICAL AGENTS USED FOR LONG-TERM TREATMENT OF PATIENTS WITH BIPOLAR I DISORDER. BASE-CASE RESULTS FOR MALE PATIENTS IN THE FORM OF GRAPHS
  • APPENDIX 18 ECONOMIC EVALUATION OF PHARMACOLOGICAL AGENTS USED FOR LONG-TERM TREATMENT OF PATIENTS WITH BIPOLAR I DISORDER. RESULTS OF SENSITIVITY ANALYSIS
  • APPENDIX 19 CONSENSUS CONFERENCE ON THE DIAGNOSIS OF BIPOLAR I DISORDER IN CHILDREN AND ADOLESCENTS
  • APPENDIX 20 CONSENSUS STATEMENT FOR THE PHARMACOLOGICAL MANAGEMENT OF PREGNANT AND LACTATING WOMEN WITH BIPOLAR DISORDER
  • APPENDIX 21 SCHEDULE FOR PHYSICAL MONITORING
  • APPENDIX 22 CHARACTERISTICS OF REVIEWED STUDIES
  • APPENDIX 23 EVIDENCE PROFILES
  • APPENDIX 24 CLINICAL EVIDENCE FOREST PLOTS
• 13. REFERENCES
• 14. ABBREVIATIONS

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).