The Management of Bipolar Affective Disorder

Before treating an episode of bipolar disorder, consideration needs to be given to whether the presentation may be due to physical illness or drug and alcohol use. An assessment of the risks should be made and a decision taken about where the person is best managed. Mood stabilising medication, antidepressants and antipsychotics are all used in bipolar affective disorder. The acute treatment of an episode of hypomania aims to prevent the episode developing in to a more severe episode of mania. During an acute episode of hypomania or mania, treatment with antipsychotic and hypnotic medication in addition to treatment with mood stabilising medication is often used. The person should be educated about how to maintain a good routine and overactivity should be discouraged. A good sleep pattern is important and night time sedation should be prescribed to obtain this, particularly during stressful periods. Antidepressants may be indicated during depressive episodes in people with bipolar affective disorder but can trigger an episode of hypomania or mania. For this reason, mood stabilising medication is the priority for treatment in bipolar affective disorder, and antidepressants, where used, should be withdrawn within a few months of recovery and are not generally considered part of maintenance treatment. Once recovery has been achieved the main component of maintenance treatment in bipolar affective disorder is mood stabilising medication. Psychological therapies to identify and manage stresses that may trigger a relapse could be useful, as may other interventions such as social rhythms therapy. The topic of psychological therapies is covered in more detail in Module 11.