What are Bipolar Disorders?
Diagnosing Bipolar Disorders
⚠️ Safety netting
If a woman with a bipolar disorder is pregnant/planning a pregnancy, and being managed solely in primary care → refer to secondary MH service.
If a woman is taking valproate and becomes pregnant → urgently refer to secondary MH service.
If there is a need for commencement/change in medication → discuss with GP or strongly consider advice from secondary MH service.
- Mixed Episode → a mixture, or rapid alternation (usually within a few hours), of manic/hypomanic and depressive symptoms.
Bipolar Disorder is a notifiable condition for the DVLA - see Bipolar disorder (manic depression) and driving - GOV.UK (www.gov.uk)
Lithium may impair performance of skilled tasks (e.g. driving, operating machinery), so patients must be made aware of the risk of driving whilst taking this medication.
Penrose Health Action Plan
Adults with bipolar disorder treated in secondary care may be transferred back to primary care for ongoing management, once their condition has stabilised.
This long term condition is reviewed annually within Penrose Health (see Severe Mental Illness (SMI)).
Patient Journey - Determining Schedule of Reviews
Click toggle for a schematic of the action plan/treatment policy for all Penrose Health Surgeries, or follow the guidance below.
Patient in Crisis → Refer/discuss with secondary MH team.
Suspected Bipolar → Liaise with other professional (e.g., PCMHT team or GP) for diagnosis/management.
Pre-existing Bipolar diagnosis → Liaise with other professional (e.g., PCMHT team or GP), and:
- if patient has no acute issues → follow annual review pathway for SMI: Severe Mental Illness (SMI).
- if acute issues → discuss with other professional (e.g., PCMHT team or GP) and consider re-booking if rejected from secondary services.
Medication
- Medication for these patients will likely be started by a GP and/or psychiatry team.
- Liaise with seniors as appropriate.
Signpost/refer to services as appropriate (see Referring Onward below).
- If a patient is actively managed by another mental health provider → liaise with services as required and conclude routine MHN appointments.
- If rejected by secondary services and patient is at high risk → review again in <1-2 weeks.
If patient remains on medication for a long-term, routine review should occur every 6 months.
If patient is not being actively managed by secondary services and still having issues, after second review → book appointment with GP.
Signpost/refer to services as appropriate (see Referring Onward below).
Referring/Signposting Onward
Below are some services to which you can signpost/refer patients. More services can be found on the Penrose Portal in Mental Health Services Database.