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National Collaborating Centre for Mental Health (UK). Bipolar Disorder: The NICE Guideline on the Assessment and Management of Bipolar Disorder in Adults, Children and Young People in Primary and Secondary Care. London: The British Psychological Society and The Royal College of Psychiatrists; 2014 Sep. (NICE Clinical Guidelines, No. 185.)
April 2018: Footnotes and cautions have been added and amended to link to the MHRA's latest advice 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. 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. See these changes in the short version of the guideline.
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Bipolar Disorder: The NICE Guideline on the Assessment and Management of Bipolar Disorder in Adults, Children and Young People in Primary and Secondary Care.
Show detailsAbbreviations
- Ari
aripiprazole
- Car
carbamazepine
- CBT
cognitive behavioural therapy
- CI
confidence interval
- CPN
community psychiatric nurse
- DSM-IV
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
- EPA
eicosapentaenoic acid
- GP
general practitioner
- HRQoL
health-related quality of life
- ICER
incremental cost-effectiveness ratio
- Imi
imipramine
- Lam
lamotrigine
- Li
lithium
- MDQ
Mood Disorder Questionnaire
- MRS
Mania Rating Scale
- MS
mood stabiliser
- NA
not applicable
- NHS
National Health Service
- Olz
olanzapine
- QALY
quality-adjusted life year
- Que
quetiapine
- RCT
randomised controlled trial
- SD
standard deviation
- SHO
senior house officer
- Val
valproate
- Ven
venlafaxine
- WTP
willingness to pay
- YMRS
Young Mania Rating Scale
- XR
extended release
1.1. Case Identification and Assessment of Adults with Bipolar Disorder
- Reference to included study:
- Menzin J, Sussman M, Tafesse E, Duczakowski C, Neumann P, Friedman M. A model of the economic impact of a bipolar disorder screening program in primary care. Journal of Clinical Psychiatry. 2009;70:1230–06. [PubMed: 19689919]
Download PDF (134K)
1.2. Pharmacological Interventions for Mania, Hypomania and Mixed Episodes in Adults with Bipolar Disorder
- References to included studies:
- Bridle C, Palmer S, Bagnall AM, Darba J, Duffy S, Sculpher M, et al. A rapid and systematic review and economic evaluation of the clinical and cost-effectiveness of newer drugs for treatment of mania associated with bipolar affective disorder. Health Technology Assessment. 2004;8. [PubMed: 15147609]
- Caro JJ, Huybrechts KF, Xenakis JG, O’Brien JA, Rajagopalan K, Lee K. Budgetary impact of treating acute bipolar mania in hospitalized patients with quetiapine: an economic analysis of clinical trials. Current Medical Research and Opinion. 2006;22:2233–42. [PubMed: 17076984]
- Revicki DA, Paramore LC, Sommerville KW, Swann AC, Zajecka JM, for the Depakote Comparator Study Group. Divalproex sodium versus olanzapine in the treatment of acute mania in bipolar disorder: health-related quality of life and medical cost outcomes. Journal of Clinical Psychiatry. 2003;64:288–94. [PubMed: 12716270]
- Zhu B, Tunis SL, Zhao Z, Baker RW, Lage MJ, Shi L, Tohen M. Service utilization and costs of olanzapine versus divalproex treatment for acute mania: results from a randomized, 47-week clinical trial. Current Medical Research and Opinion. 2005;21:555–64. [PubMed: 15899104]
Download PDF (184K)
1.3. Pharmacological Interventions for Acute Depression in Adults with Bipolar Disorder
- Reference to included study:
- Ekman M, Lindgren P, Miltenburger C, Meier G, Locklear JC, Chatterton ML. Cost effectiveness of quetiapine in patients with acute bipolar depression and in maintenance treatment after an acute depressive episode. PharmacoEconomics. 2012;30:513–30. [PubMed: 22591130]
Download PDF (140K)
1.4. Services for Adults with Bipolar Disorder – Mood Disorder Clinics
- Reference to included study:
- Kessing LV, Hansen HV, Hvenegaard A, Christensen EM, Dam H, Gluud C, et al. Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. British Journal of Psychiatry. 2013;202:212–9. [PubMed: 23349295]
Download PDF (137K)
1.5. Pharmacological Interventions for the Long-Term Management of Adults with Bipolar Disorder
- References to included studies:
- Calvert NW, Burch SP, Fu AZ, Reeves P, Thompson TR. The cost-effectiveness of lamotrigine in the maintenance treatment of adults with bipolar I disorder. Journal of Managed Care Pharmacy. 2006;12:322–30. [PMC free article: PMC10437984] [PubMed: 16792438]
- Ekman M, Lindgren P, Miltenburger C, Meier G, Locklear JC, Chatterton ML. Cost-effectiveness of quetiapine in patients with acute bipolar depression and in maintenance treatment after an acute depressive episode. PharmacoEconomics. 2012;30:513–30. [PubMed: 22591130]
- Fajutrao L, Paulsson B, Liu S, Locklear J. Cost-effectiveness of quetiapine plus mood stabilizers compared with mood stabilizers alone in the maintenance therapy of bipolar I disorder: Results of a Markov model analysis. Clinical Therapeutics. 2009;3:1456–68. [PubMed: 19698903]
- McKendrick J, Cerri KH, Lloyd A, D’Ausilio A, Dando S, Chinn C. Cost effectiveness of olanzapine in prevention of affective episodes in bipolar disorder in the United Kingdom. Journal of Psychopharmacology. 2007;21:588–96. [PubMed: 17050661]
- NCCMH (2006) Bipolar Disorder: the Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care. Leicester and London: The British Psychological Society and the Royal College of Psychiatrists.
- Revicki DA, Hirschfeld RM, Ahearn EP, Weisler RH, Palmer C, Keck PE Jr. Effectiveness and medical costs of divalproex versus lithium in the treatment of bipolar disorder: results of a naturalistic clinical trial. Journal of Affective Disorders. 2005;86:183–93. [PubMed: 15935238]
- Soares-Weiser K, Bravo Vergel Y, Beynon S, Dunn G, Barbieri M, Duffy S, et al. A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder. Health Technology Assessment. 2007;11. [PubMed: 17903393]
- Woodward TC, Tafesse E, Quon P, Kim J, Lazarus A. Cost-effectiveness of quetiapine with lithium or divalproex for maintenance treatment of bipolar I disorder. Journal of Medical Economics 2009;12:259–68. [PubMed: 19769548]
- Woodward TC, Tafesse E, Quon P, Lazarus A. Cost effectiveness of adjunctive quetiapine fumarate extended-release tablets with mood stabilizers in the maintenance treatment of bipolar I disorder. PharmacoEconomics. 2010;28:751–64. [PubMed: 20623994]
Download PDF (297K)
1.6. Nutritional Interventions for the Long-Term Management of Adults with Bipolar Disorder
- Reference to included study:
- Cheema N, Frangou S, McCrone P. Cost-effectiveness of ethyleicosapentaenoic acid in the treatment of bipolar disorder. Therapeutic Advances in Psychopharmacology. 2013;3:73–81. [PMC free article: PMC3805392] [PubMed: 24167678]
Download PDF (134K)
1.7. Psychological and Psychosocial Interventions for Adults with Bipolar Disorder
- References to included studies:
- Lam DH, McCrone P, Wright K, Kerr N. Cost-effectiveness of relapse-prevention cognitive therapy for bipolar disorder: 30-Month study. British Journal of Psychiatry. 2005;186:500–06. [PubMed: 15928361]
- Scott J, Colom F, Popova E, Benabarre A, Cruz N, Valenti M, et al. Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis. Journal of Clinical Psychiatry. 2009;70:378–86 [PubMed: 19284929]
Download PDF (170K)
1.8. Pharmacological Interventions for Mania, Hypomania and Mixed Episodes in Children and Young People with Bipolar Disorder
- Reference to included study:
- Uttley L, Kearns B, Ren S, Stevenson M. Aripiprazole for the treatment and prevention of acute manic and mixed episodes in bipolar I disorder in children and adolescents: a NICE single technology appraisal. PharmacoEconomics. 2013;31:981–90. [PubMed: 24092620]
Download PDF (136K)
- Abbreviations
- Case Identification and Assessment of Adults with Bipolar Disorder
- Pharmacological Interventions for Mania, Hypomania and Mixed Episodes in Adults with Bipolar Disorder
- Pharmacological Interventions for Acute Depression in Adults with Bipolar Disorder
- Services for Adults with Bipolar Disorder – Mood Disorder Clinics
- Pharmacological Interventions for the Long-Term Management of Adults with Bipolar Disorder
- Nutritional Interventions for the Long-Term Management of Adults with Bipolar Disorder
- Psychological and Psychosocial Interventions for Adults with Bipolar Disorder
- Pharmacological Interventions for Mania, Hypomania and Mixed Episodes in Children and Young People with Bipolar Disorder
- Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care (NICE guideline CG38)
- Surveillance report 2017: Bipolar disorder: assessment and management (2014) NICE guideline CG185
- NICE Clinical Guideline 185: Bipolar disorder: assessment and management
- Health Economics – Evidence Tables - Bipolar DisorderHealth Economics – Evidence Tables - Bipolar Disorder
- Review Protocols and Questions - Bipolar DisorderReview Protocols and Questions - Bipolar Disorder
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