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National Institute for Health and Clinical Excellence (NICE) July 2006

BIPOLAR DISORDER The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. National Institute for Health and Clinical Excellence (NICE) July 2006. General guidance for psychology: Working with patients and families. Collaborative relationships

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National Institute for Health and Clinical Excellence (NICE) July 2006

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  1. BIPOLAR DISORDERThe management of bipolar disorder in adults, children and adolescents, in primary and secondary care National Institute for Health and Clinical Excellence (NICE) July 2006

  2. General guidance for psychology:Working with patients and families • Collaborative relationships • Advise on self-monitoring, lifestyle, coping • Advance directives • Consider impact on relationships, parenting; carer’s needs • Accessibility

  3. General guidance for psychology:Specific groups of patients • Coincidence of learning disability, personality difficulty: offer same care for bipolar disorder • Coincidence of substance misuse: psychosocial intervention

  4. General guidance for psychology:Recognition and treatment pathway • Refer urgently for acute mania, severe depression • Refer promptly for hypomania • Consider review if functioning declines or response to treatment is poor • Risk assessment, crisis plan with triggers • Treat as severe mental illness; offer specialist services accordingly

  5. General guidance for psychology:Healthy lifestyle, relapse prevention • Advice on sleep and daily routine • Risks of shift work, long hours, flights • Methods of self-monitoring • Extra support after difficult life events • Collaborative relapse prevention strategy

  6. Specific guidance for psychology:Symptom clusters • Depression: 16-20 sessions CBT for chronic/recurrent depressive symptoms (Use CBT in preference to antidepressants in pregnancy-planning women) • Anxiety: Focussed psychological treatment

  7. Specific guidance for psychology:Post-acute episode--individual • Consider individual structured psychological interventions, such as CBT • 16 sessions over 6-9 months • Psychoeducation • Relapse prevention • Enhance general coping • Delivered by those familiar with bipolar patients

  8. Specific guidance for psychology:Post-acute episode—family, psychosocial intervention • Consider family intervention, 6-9 months • Psychoeducation • Improved communication • Problem solving • Befriending schemes

  9. Workshop—Case vignettes • 3 questions: Each group can ask 3 questions to contribute to their understanding of the case • Consider the risks • Develop a formulation • Accordingly, develop a therapeutic care plan

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