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'Referral advice' recommendation details

Bipolar disorder

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG38 Primary care clinicians should normally refer patients with suspected bipolar disorder for a specialist mental health assessment and development of a care plan, if either of the following are present: periods of overactive, disinhibited behaviour lasting at least 4 days with or without periods of depression, or three or more recurrent depressive episodes in the context of a history of overactive, disinhibited behaviour. Primary care clinicians should urgently refer patients with mania or severe depression who are a danger to themselves or other people, to specialist mental health services. When a patient with existing bipolar disorder registers with a practice, the GP should consider referring them for assessment by specialist mental health services. When a patient with bipolar disorder is managed solely in primary care, an urgent referral to secondary care services should be made if: there is an acute exacerbation of symptoms, development of mania or severe depression, an increase in the degree of risk, or change in the nature of risk, to self or others. When a patient with bipolar disorder is managed solely in primary care, a review by secondary care services or increased contact in primary care should be considered if: the patient's functioning declines significantly, their condition responds poorly to treatment, treatment adherence is a problem, comorbid alcohol and/or drug misuse is suspected or the patient is considering stopping prophylactic medication after a period of relatively stable mood. Urgent
CG38 Referral to a community mental health team should be considered for people with bipolar disorder who: - have problems in engaging with, and maintaining regular contact with services such as outpatient care - experience frequent relapses, poor symptom control, continuing functional impairment, or comorbid anxiety disorders - are at risk of suicide, or harm to self or others, including self-neglect or exploitation - have problems adhering to medication regimes or with chronic alcohol and/or drug misuse. Time frame not specified
CG38 If a patient's depressive symptoms have failed to respond to at least three courses of treatment for depression of adequate dose and duration, seeking the advice of, or referral to, a clinician with a specialist interest in treating bipolar disorder should be considered. Time frame not specified
CG38 In severely mentally ill children and adolescents with psychotic symptoms, a diagnosis should be attempted as early as practical, and should be subject to regular specialist review. Time frame not specified

This page was last updated: 22 August 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.