Transcript BIPOLAR DISORDER The management of bipolar disorder in adults

BIPOLAR DISORDER
The management of bipolar
disorder in adults, children and
adolescents, in primary and
secondary care
National Institute for Health and
Clinical Excellence (NICE)
July 2006
General guidance for psychology:
Working with patients and families
• Collaborative relationships
• Advise on self-monitoring, lifestyle, coping
• Advance directives
• Consider impact on relationships,
parenting; carer’s needs
• Accessibility
General guidance for psychology:
Specific groups of patients
• Coincidence of learning disability,
personality difficulty: offer same care for
bipolar disorder
• Coincidence of substance misuse:
psychosocial intervention
General guidance for psychology:
Recognition and treatment pathway
• Refer urgently for acute mania, severe
depression
• Refer promptly for hypomania
• Consider review if functioning declines or
response to treatment is poor
• Risk assessment, crisis plan with triggers
• Treat as severe mental illness; offer
specialist services accordingly
General guidance for psychology:
Healthy lifestyle, relapse prevention
• Advice on sleep and daily routine
• Risks of shift work, long hours, flights
• Methods of self-monitoring
• Extra support after difficult life events
• Collaborative relapse prevention strategy
Specific guidance for psychology:
Symptom clusters
• Depression: 16-20 sessions CBT for
chronic/recurrent depressive symptoms
(Use CBT in preference to antidepressants
in pregnancy-planning women)
• Anxiety: Focussed psychological
treatment
Specific guidance for psychology:
Post-acute episode--individual
• Consider individual structured
psychological interventions, such as CBT
• 16 sessions over 6-9 months
– Psychoeducation
– Relapse prevention
– Enhance general coping
– Delivered by those familiar with bipolar
patients
Specific guidance for psychology:
Post-acute episode—family,
psychosocial intervention
• Consider family intervention, 6-9 months
– Psychoeducation
– Improved communication
– Problem solving
• Befriending schemes
Workshop—Case vignettes
• 3 questions: Each group can ask 3
questions to contribute to their
understanding of the case
• Consider the risks
• Develop a formulation
• Accordingly, develop a therapeutic care
plan