Bipolar is a serious condition that affects someone’s moods. They experience episodes of mania, where they may feel overactive or irritable, and episodes of depression, when they will feel very low. This newly updated guideline focuses on recognising, assessing and managing bipolar disorder in children, young people and adults. It also includes specific recommendations for diagnosis of children and young people – this is a particularly important group as they may have another condition alongside bipolar disorder, such as ADHD.
Professor Mark Baker, Centre for Clinical Practice director, NICE, 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.”
Professor Richard Morriss, a consultant psychiatrist and chair of the group that developed the guideline, 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.”
Carnice John, who represented the views of service users and carers on the group that developed the guideline, 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."
Updated recommendations include:
Care for adults, children and young people across all phases of bipolar disorder
- Support for carers of people with bipolar disorder: As early as possible negotiate with the person with bipolar disorder and their carers about how information about the person will be shared. When discussing rights to confidentiality, emphasise the importance of sharing information about risks and the need for carers to understand the person’s perspective. Foster a collaborative approach that supports both people with bipolar disorder and their carers, and respects their individual needs and interdependence.
Management of bipolar disorder in adults:
Management of depression
- Adults with bipolar depression should be offered a psychological intervention that has been developed specifically for bipolar disorder and has a published evidence-based manual describing how it should be delivered or a high-intensity psychological intervention (cognitive behavioural therapy, interpersonal therapy or behavioural couples therapy) in line with the NICE clinical guideline on depression. Discuss with the person the possible benefits and risks of psychological interventions and their preference. Monitor mood carefully for signs of mania or hypomania or deterioration of the depressive symptoms.
- If a person develops moderate or severe bipolar depression and is not taking a drug to treat their bipolar disorder, offer fluoxetine combined with olanzapine, or quetiapine on its own, depending on the person’s preference and previous response to treatment. If the person prefers, consider either olanzapine (without fluoxetine) or lamotrigine on its own. If there is no response to fluoxetine combined with olanzapine, or quetiapine, consider lamotrigine on its own.
Longer-term treatment in adults:
- A structured psychological intervention (individual, group or family), which has been designed for bipolar disorder and has a published evidence-based manual describing how it should be delivered, should be offered to prevent relapse or for people who have some persisting symptoms between episodes of mania or bipolar depression.
- When planning long-term pharmacological treatment to prevent relapse, take into account drugs that have been effective during episodes of mania or bipolar depression. Discuss with the person whether they prefer to continue this treatment or switch to lithium, and explain that lithium is the most effective long-term treatment for bipolar disorder.
The final guidance will be available on the NICE website (www.nice.org.uk) from 24 September.
For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.
Notes to Editors
About the guidance
The guidance will be available at http://www.nice.org.uk/guidance/CG185 from Wednesday 24 September 2014.
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