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Offer bipolar adults specific, proven intervention

Carers of those with bipolar disorder need greater support and involvement

Louise Prime

Wednesday, 24 September 2014

GPs should offer adults with bipolar depression a psychological intervention specifically developed for the disorder that has a published evidence-based manual describing how to deliver it, advises the National Institute of Health and Care Excellence. As an alternative, NICE says in its latest updated guidance* on the recognition, assessment and management of bipolar disorder in people of all ages, GPs can offer a high-intensity psychological intervention – such as cognitive behavioural therapy, interpersonal therapy or behavioural couples therapy – in line with its separate clinical guideline on depression.

NICE advises GPs to talk to patients about the possible benefits and risks of psychological interventions, and about their preference. They should also carefully monitor mood and, if the patient shows signs of hypomania or their depressive symptoms deteriorate, refer them to secondary care – and do so urgently if they develop mania or severe depression.

One of NICE’s key recommendations, which it says should be implemented as a priority, is about offering more support to carers of people with bipolar disease. It says GPs should at the earliest opportunity negotiate with the person with bipolar disorder and their carers about how information will be shared. They should foster collaboration, while at the same time respecting their individual needs and interdependence. And when discussing rights to confidentiality, GPs should emphasise the importance of sharing information about risks, as well as for carers to appreciate the person’s perspective.

NICE points out that it can be particularly difficult to diagnose bipolar disorder in children and young people, as they may also have another condition such as attention deficit hyperactivity disorder, and it makes specific recommendations for this age group. It says that any diagnosis should be preceded by a period of intensive, prospective longitudinal monitoring by a healthcare professional or multidisciplinary team trained and experienced in the assessment, diagnosis and management of bipolar disorder in children and young people, and in collaboration with the child or young person’s parents or carers.

Director of NICE’s Centre for Clinical Practice Professor Mark Baker said: “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.”

Consultant psychiatrist Professor Richard Morriss, who chaired the guideline development group, added: “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.”

* Bipolar disorder: the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. NICE CG185, 2014

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