1 May 2005
Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]
Summary,

GUIDELINE OBJECTIVE(S)

To present evidence-based recommendations for the management of bipolar affective disorder

TARGET POPULATION

Adults (aged 18 years or over) with bipolar affective disorder

INTERVENTIONS AND PRACTICES CONSIDERED

Diagnosis

1. Assess signs and symptoms of mania and hypomania, depression, psychotic symptoms, and mixed affective states
2. Clinical assessment according to criteria from the International Classification of Diseases of the World Health Organisation, 10th edition (ICD-10) and the Diagnostic and Statistical Manual, 4th edition (DSM-IV)
3. Clinical Interview for DSM (SCID)
4. Present State Examination (PSE)
5. Diagnostic scales

Treatment

Acute Mania

1. Antipsychotic drugs
2. Valproic acid salts
3. Carbamazepine
4. Other anticonvulsants
5. Lithium alone or in combination with an antipsychotic
6. Benzodiazepines
7. Electroconvulsive treatment (ECT)
8. Reduction or discontinuation of antidepressant drug treatment

Acute Depression

1. Antidepressant drugs in combination with antimanic drug
2. Lamotrigine
3. Electroconvulsive treatment

Rapid Cycling and Mixed Affective States

Note: Guideline developers considered but did not specifically recommend lithium, antipsychotic drugs, anticonvulsant mood stabilizers, or valproate for rapid cycling and mixed affective states

Management

1. Pharmacologic relapse prevention
* Lithium
* Carbamazepine
* Lamotrigine

Note: Guideline developers considered but did not recommend valproic acid salts, antipsychotic medications, or antidepressant drugs for relapse prevention
2. Psychosocial interventions
3. Reproductive health issues
* Contraception
* Preconception counseling
* Drugs in pregnancy

Note: Guideline developers considered but did not recommend newer antipsychotic drugs during pregnancy. They discussed but did not offer specific recommendations regarding antidepressant drug use during pregnancy.
* Drug treatment and lactation

4. Substance misuse
* Manage under Care Programme Approach (CPA)
5. Suicide prevention
* Optimize acute and maintenance lithium treatment

MAJOR OUTCOMES CONSIDERED

* Accuracy of diagnostic tools (e.g., sensitivity and specificity of diagnostic scales)
* Effectiveness of treatments on stabilizing mood and preventing relapse
* Morbidity and mortality associated with bipolar affective disorder
* Adverse effects of medication used to treat bipolar disorder