F31.0-9 + (F10.0-F19.9/R45.0-8/Z65.0-5/Z65.8-9/Z81.0-4/ Z81.8)
DESCRIPTION
A lifelong illness which may have an episodic, variable course with the presenting episode being manic, hypomanic, mixed or depressive (according to accepted diagnostic criteria). An episode of mania is typically characterised by an elevated mood where a patient may experience extreme happiness, lasting days to weeks, which might also be associated with an underlying irritability. Such mood is associated with increased energy/activity, talkativeness and a reduction in the need for sleep, and features may be accompanied by grandiose and/or religious delusions.
The diagnosis of Bipolar Disorder should be confirmed by a specialist. It may present with any mood state, e.g. with treatment resistant depression. The diagnosis requires either a current or previous episode of mania (Bipolar I Disorder) or hypomania (Bipolar II Disorder), but this history is not always clear, in which case a trial of treatment may be indicated. In stable patients with good insight and support, PHC may continue treatment and management of comorbid medical conditions.
Comorbid substance use is common. It may confuse the clinical presentation and may cause poor adherence to medication. The ‘dual diagnosis’ of bipolar disorder and an addiction requires referral to a specialist and ongoing monitoring after discharge.
GENERAL MEASURES
Reassurance and support of the patient and family.
MEDICINE TREATMENT
For manic, agitated and acutely disturbed patients:
- Stop antidepressants if prescribed.
- Manage as for the aggressive or disruptive patient. See: Aggressive disruptive behaviour in adults.
REFERRAL
All patients.