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NICE: Updated bipolar disorder guidance

National Institute of Health and Care Excellence (NICE) has published an updated guidance for diagnosis and management of bipolar disorder.

The updated publication focuses on assessing, recognising and managing bipolar in children, young people and adults. 

Attention Deficit Hyperactive Disorder (ADHD) is often clinically observed alongside bipolar in young people, making the new recommendations particularly important for this age group.

Director of the Centre for Clinical Practice, NICE, Professor Mark Baker believes the updated information contains “important advances”.

He said: “Since the publication of the previous NICE guideline in 2006, there have been some important advances in what we know about which treatment approaches are most likely to benefit people with bipolar disorder. 

“The guideline has been updated to reflect this new knowledge and sets out the criteria for when patients need to be referred on for specialist psychiatric assessment and treatment. It also sets out the drug treatment options for people with bipolar disorder and emphasises the need to involve the individual patient in treatment decisions. 

“The majority of people with the disorder begin to experience symptoms in their teens; however it often goes unrecognised or misdiagnosed for many years. More needs to be done to raise awareness of the condition. This guideline provides information for young people, parents, carers and professionals on the signs to look out for to recognise the condition early and treat it appropriately.”

Representative of the views of service users and carers on the group that developed the guideline, John Carney thinks the guidelines could make a “real difference to people's lives”.

He said: “Bipolar disorder is linked to trauma which I have had much of during my life, especially during the early years. After being sectioned at the age of 17, I slipped through the system and spent years self-medicating.  Had I known that NICE guidelines existed I would have sought the help I needed so badly.  Not all of us have support networks but the guidelines can make a real difference to people's lives.  

“They provide information on this condition in an easy to understand format, they provide hope for recovery in order to achieve fulfilling lives, they can help alleviate suffering and may save lives and can educate those who know little about this complex but controllable illness."

Consultant psychiatrist and chair of the group that developed the guideline, Professor Richard Morriss said: “Bipolar disorder is more common than is often thought, with 1.4% of the population affected at some point in their lifetime. However, there are effective treatments available and if it is recognised early, through continuing treatment and care, people with bipolar disorder can lead relatively normal and fulfilling lives.

“There have been many developments since the original recommendations were published - we now know more about drug and psychological treatments and their service delivery in adults and adolescents. We have also highlighted the support offered to carers as a key priority in the new guideline and what can be done to improve the physical and mental health of people with bipolar disorder.”

The recommendations include:

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

Support for carers of people with bipolar disorder

An important step in the early stages is agreeing the way in which information is shared between the person with bipolar and the carer.

Emphasis should be placed on confidentiality, the importance of sharing information and the carer understanding the patient's perspective

2. Management of bipolar disorder in adults

Management of depression

Specifically tailored treatment options for bipolar disorder should be offered to the patient, with an evidence-based manual describing how the therapy should be delivered.

High-intensity psychological interventions should also be accessible, which include cognitive behavioural therapy, interpersonal therapy or behavioural couples therapy.

Monitor mood of patient for signs of hypomania or deterioration of depressive symptoms.

Patients that develop moderate to severe and is not currently taking a drug, offer fluoxetine combined with olanzapine, or quetiapine on its own, depending on person's preference and response to the treatment

Alternatively, olanzapine or can lamotrigine can both be considered on their own, depending on the person's preference.

3. Longer-term treatment in adults:

Specifically designed psychological interventions for bipolar disorder should made available to prevent relapse, or, for people with persisting symptoms between manic and depressive episodes.

Note which drugs have been effective during episodes and discuss whether the patient would like to continue the treatment or switch to lithium, which is considered the most efficacious long-term drug.