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Bipolar should not be confused with mood instability.
The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V) provides diagnostic criteria for biploar disorder.
Other causes for manic or depressive symptoms include;
If a patient is psychotic please consider Gloucestershire Recovery in Psychosis (GRiP)
Comorbidity is common amongst bipolar patients. Regardless of the comorbidities that may exist the bipolar should be addressed and treated seperately.
It may also be useful to ask the patients partner/carer/parents for more information with their consent.
Enquire into past medical history.
Consider asking the following:
Yes to any questions should prompt further evaluation. According to NICE guidance, questionnaires should not be used in Primary Care.
Refer all suspected cases for a specialist mental health assessment/ diagnostic confirmation if patient has experienced overactivity or disinhibited behaviour lasting four days or more. Refer urgently if they are a danger to themselves or others. Do not start selective serotonin re-uptake inhibitors (SSRI's) in the depressed phase as they are ineffective, and may be harmful. NICE also says do not start lithium, valproate, gabapentin or topirmate in Primary Care to treat bipolar disorder.
Consider talking to the Mental Health Intermediate Care (MH ICT) nurse for further advice/ assessment/ support and local services
Contact details and referral advice for the Contact Centre, Mental Health Acute Response Service (MHARS) (formerly Crisis Resolution and Home Treatment Teams) and other mental health services that accept direct referral are available here.
Provide advice/refer/signpost patients to any of the following self-management services;
Consider referral to signpost patient to Change, Grow, Live, Gloucestershire's Community Drug & Alcohol Recovery Service
The Contact Centre may be contacted for advice at any stage:
The Gloucestershire Council Social Care Helpdesk may also be contact for support:
Recent reviews of serious incidents have identified potential system and process changes which could improve the quality and responsiveness of care for people who require secondary care mental health services.
It would be helpful if GPs could please share any information in relation to substance misuse with GHC, particularly when a patient is injecting, as this aids clinical risk assessment and management. It is also really helpful if referrals into mental health services contain an appropriate risk assessment.
In all instances when a patient dies unexpectedly, especially if the cause of death is suspected suicide, GPs should inform GHC as soon as possible. This will allow GHC to quickly put in place support for those bereaved and minimise the risk of appointment letters etc. being sent to the deceased.
Contact: email@example.com (Assistant Director of Governance & Compliance, GHCNHSFT)