Excerpt

This guideline, which updates the 2006 National Institute for Health and Care Excellence (NICE) guideline (NCCMH, 2006; NICE, 2006), has been developed to advise on the assessment and management of bipolar disorder in adults, children (aged under 13 years) and young people (aged 13 to 18 years) in primary and secondary care. It applies to people with bipolar I, bipolar II, mixed affective and rapid cycling disorders. Non-bipolar affective disorders are not covered because these are addressed by other guidelines.

The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, people with bipolar disorder and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for people with bipolar disorder (see Appendix 1 for more details on the scope of the guideline).

Although the evidence base is rapidly expanding, there are a number of major gaps. The guideline makes a number of research recommendations specifically to address gaps in the evidence base. In the meantime, it is hoped that the guideline will assist clinicians, and people with bipolar disorder and their carers by identifying the merits of particular treatment approaches where the evidence from research and clinical experience exists.

Contents

• Guideline Development Group Members and National Collaborating Centre for Mental Health (NCCMH) Review Team
• Acknowledgements
• 1. Preface
• 2. Introduction to Bipolar Disorder
  • 2.1. The Disorder
  • 2.2. Aetiology
  • 2.3. Diagnosis of Adults
  • 2.4. Diagnosis of Children and Young People
  • 2.5. Course and Prognosis
  • 2.6. The Treatment and Management of Bipolar Disorder
  • 2.7. Economic Costs
• 3. Methods Used to Develop this Guideline
  • 3.1. Overview
  • 3.2. The Scope
  • 3.3. The Guideline Development Group
  • 3.4. Review Protocols
  • 3.5. Clinical Review Methods
  • 3.6. Health Economics Methods
  • 3.7. Using Nice Evidence Reviews and Recommendations from Existing Nice Clinical Guidelines
  • 3.8. From Evidence to Recommendations
  • 3.9. Stakeholder Contributions
  • 3.10. Validation of the Guideline
• 4. Improving the Experience of Carers
  • 4.1. Introduction
  • 4.2. Review of the Evidence
  • 4.3. Linking Evidence to Recommendations
  • 4.4. Recommendations
• 5. Case Identification and Assessment in Adults, Children and Young People
  • 5.1. Introduction
  • 5.2. Case Identification
  • 5.3. Assessment
  • 5.4. Immediate Post-Assessment Period
  • 5.5. Linking Evidence to Recommendations
  • 5.6. Recommendations
• 6. Pharmacological and Medical Interventions for Acute Episodes
  • 6.1. Introduction
  • 6.2. Pharmacological and Nutritional Interventions for Mania, Hypomania and Mixed Episodes
  • 6.3. Pharmacological and Nutritional Interventions for Acute Episodes of Bipolar Depression
  • 6.4. Non-Pharmacological Interventions for Acute Episodes
  • 6.5. Linking Evidence to Recommendations
  • 6.6. Recommendations
• 7. Interventions and Services for Long-Term Management
  • 7.1. Introduction
  • 7.2. Service-Level Interventions
  • 7.3. Communication Technologies
  • 7.4. Pharmacological and Nutritional Interventions
  • 7.5. Linking Evidence to Recommendations
  • 7.6. Recommendations
• 8. Psychological and Psychosocial Interventions for Acute Episodes and Long-Term Management in Adults
  • 8.1. Introduction
  • 8.2. Linking Evidence to Recommendations
  • 8.3. Recommendations
• 9. Management of Physical Health in Adults
  • 9.1. Introduction
  • 9.2. Interventions to Promote Physical Activity and Healthy Eating
  • 9.3. Linking Evidence to Recommendations
  • 9.4. Recommendations
• 10. Interventions for Children and Young People
  • 10.1. Introduction
  • 10.2. Service-Level Interventions
  • 10.3. Pharmacological and Nutritional Interventions for Mania
  • 10.4. Pharmacological and Nutritional Interventions for Acute Episodes of Bipolar Depression
  • 10.5. Pharmacological and Nutritional Interventions for Long-Term Management
  • 10.6. Psychological Interventions for Acute Episodes of Bipolar Depression and/or Long-Term Management
  • 10.7. Linking Evidence to Recommendations
  • 10.8. Recommendations
• 11. Summary of Recommendations
  • 11.1. Care for Adults, Children and Young People Across All Phases of Bipolar Disorder
  • 11.2. Recognising and Managing Bipolar Disorder in Adults in Primary Care
  • 11.3. Assessing Suspected Bipolar Disorder in Adults in Secondary Care
  • 11.4. Managing Crisis, Risk and Behaviour that Challenges in Adults with Bipolar Disorder in Secondary Care
  • 11.5. Managing Mania or Hypomania in Adults in Secondary Care
  • 11.6. Managing Bipolar Depression in Adults in Secondary Care
  • 11.7. Managing Bipolar Disorder in Adults in the Longer Term in Secondary Care
  • 11.8. Monitoring Physical Health in Secondary Care
  • 11.9. Promoting Recovery and Return to Primary Care
  • 11.10. How to Use Medication
  • 11.11. Recognising, Diagnosing and Managing Bipolar Disorder in Children and Young People
• 12. References
• 13. Abbreviations
• Appendices
  • APPENDIX 1. Scope for the Development of the Clinical Guideline
  • APPENDIX 2. Declarations of Interests by Guideline Development Group Members
  • APPENDIX 3. Special Advisors to the Guideline Development Group
  • APPENDIX 4. Stakeholders WHO Responded to Early Requests for Evidence
  • APPENDIX 5. Stakeholders and Experts WHO Submitted Comments in Response to the Consultation Draft of the Guideline
  • APPENDIX 6. Researchers Contacted to Request Information about Unpublished or Soon-to-be Published Studies
  • APPENDIX 7. Review Protocols and Questions
  • APPENDIX 8. Search Strategies for the Identification of Clinical Studies
  • APPENDIX 9. Search Strategies for the Identification of Health Economics Evidence
  • APPENDIX 10. Research Recommendations
• APPENDIX 11. Case Identification - Study Characteristics and Risk of Bias Tables
• APPENDIX 12. Interventions for Mania - Study Characteristics
• APPENDIX 13. Interventions for Mania – Forest Plots
• APPENDIX 14. Nutritional and Physical Interventions for Mania – GRADE Profiles
• APPENDIX 15. Interventions for Acute Depression – Network Meta-Analysis Plots and WinBUGS Code
  Sofia Dias and Tony Ades.
• APPENDIX 16. Interventions for Acute Depression – Study Characteristics
• APPENDIX 17. Interventions for Acute Depression – Risk of Bias Tables
• APPENDIX 18. Nutritional and Physical Interventions for Acute Depression – GRADE Profiles
• APPENDIX 19. Interventions for Long-Term Management – Study Characteristics
• APPENDIX 20. Interventions for Long-Term Management – Risk of Bias Table
• APPENDIX 21. Interventions for Long-Term Management – Forest Plots
• APPENDIX 22. Interventions for Long-Term Management – GRADE Profiles
• APPENDIX 23. Psychological and Psychosocial Interventions – Study Characteristics
• APPENDIX 24. Psychological and Psychosocial Interventions – Risk of Bias Table
• APPENDIX 25. Psychological and Psychosocial Interventions – Forest Plots
• APPENDIX 26. Psychological and Psychosocial Interventions – GRADE Profiles
• APPENDIX 27. Interventions for Children and Young People – Study Characteristics
• APPENDIX 28. Interventions for Children and Young People – Risk of Bias Table
• APPENDIX 29. Interventions for Children and Young People – Forest Plots
• APPENDIX 30. Interventions for Children and Young People – GRADE Profiles
• APPENDIX 31. Health Economics - Methodology Checklistsfor Economic Evaluations
• APPENDIX 32. Health Economics – Evidence Tables
• APPENDIX 33. Health Economics – Economic Evidence Profiles
• APPENDIX 34. Excluded Studies
• APPENDIX 35. Data Extraction Table
• APPENDIX 36. Pharmacological Interventions for Mania – Sensitivity Analysis

April 2018: Footnotes and cautions have been added and amended to link to the MHRA’s latest advise and resources on sodium valproate. Sodium valproate must not be used in pregnancy, and only used in girls and women when there is no alternative and a pregnancy prevention plan is in place. This is because of the risk of malformations and developmental abnormalities in the baby.

See these changes in the short version of the guideline at: http://www.nice.org.uk/guidance/CG185.

November 2017: Footnotes for some recommendations were updated with current UK marketing authorisations and MHRA advice. Links to other guidelines have also been updated. Some research recommendations have been stood down.

These changes can be seen in the short version of the guideline at: http://www.nice.org.uk./guidance/CG185

National Institute for Health and Care Excellence