Practice Guidelines

Assessment and management of bipolar disorder: summary of updated NICE guidance

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5673 (Published 25 September 2014) Cite this as: BMJ 2014;349:g5673
  1. Tim Kendall, director, consultant psychiatrist12,
  2. Richard Morriss, professor of psychiatry and community mental health3,
  3. Evan Mayo-Wilson, assistant scientist4,
  4. Elena Marcus, research assistant56
  5. on behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London E1 8AA, UK
  2. 2Sheffield Health and Social Care NHS Foundation Trust, Sheffield S10 3TH, UK
  3. 3Psychiatry and Applied Psychology, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
  4. 4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  5. 5National Collaborating Centre for Mental Health, University College London, London, UK
  6. 6Centre for Outcomes Research and Effectiveness, University College London, London, UK
  1. Correspondence to: T Kendall tim2.kendall{at}virgin.net

Bipolar disorder is a complex, recurrent, and severe mental illness that has an onset typically between 13 and 30 years of age and a lifetime prevalence of 1.4%.1 It is characterised by episodes of mania or hypomania with elation, overactivity, and disinhibited behaviour, as well as episodes of depression with profound loss of interest and motivation, often with milder depressed mood in between episodes. Bipolar disorder is associated with an increased risk of suicide and physical illness, such as ischaemic heart disease, diabetes, chronic obstructive airways disease, pneumonia, and unintentional injury.2 Around two thirds of people with bipolar disorder also experience another mental disorder, usually anxiety disorders, substance misuse disorders, or impulse control disorders.1 The risk of recurrence in the year after a mood episode is especially high (50% in one year and >70% at four years) compared with other psychiatric disorders,3 and this has important implications for the long term management of the disorder.

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on assessing and managing bipolar disorder in adults, children, and young people.4

Recommendations

NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Care for adults, children, and young people across all phases of bipolar disorder

  • Use this guideline in conjunction with the NICE clinical guidance on service user experience in adult mental health5 to improve the experience of care by:

    • -Promoting a positive recovery message from the point of diagnosis and throughout care

    • -Building supportive and empathic relationships as an essential part of care. (New recommendation.) [Based on the experience and opinion of …

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