Skip to Main Content


Patient Care Process for the Management of Bipolar Disorder



  • Patient characteristics (e.g., age, race, sex, pregnant)

  • Patient psychiatric, medical, social, and family history

  • Current medications and prior medication use

  • Current and past sleep habits/patterns

  • Objective data

    • BP, heart rate, height, weight, and BMI

    • Laboratory test (e.g., serum electrolytes, Scr, LFTs, TSH)

    • Rating scale scores (YMRS, HAM-D, PHQ-9)


  • Presence of hypomania, mania or depression (see Table 69-2)

  • Adherence to medication regimen

  • Appropriateness and effectiveness of current medication regimen

  • Serum concentration of medication if appropriate (e.g., lithium)

  • Current medications that may contribute to or worsen mania or depression

  • Suicidality

  • Current sleep patterns

  • If no response to current medication regimen, reassess diagnosis


  • If euthymic, continue current regimen if appropriate

  • If manic, immediately discontinue antidepressant, optimize regimen, and consider short term use of benzodiazepine (see Table 69-5)

  • If depressed, optimize regimen and consider adding antipsychotic (i.e., quetiapine or lurasidone) (see Table 69-5)

  • Lifestyle modifications (e.g., nutrition, sleep, exercise, stress reduction)

  • Monitor for efficacy and safety of medications (see Table 69-7)

  • Treat comorbid psychiatric disease states

  • Patient education (e.g. purpose of treatment, lifestyle modification, drug therapy)

  • Self-monitoring for new mood episodes (daily mood chart) and sleep patterns

  • Referrals to other providers when appropriate (e.g., psychologist, psychiatrist)


  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up

Follow-up: Monitor and Evaluate

  • Patient's psychiatric status (rating scale) and safety (suicidality)

  • Presence of adverse effects (e.g., weight gain, sedation)

  • Laboratory test (see Table 69-7)

  • Patient adherence to treatment plan using multiple sources of information and presence of residual symptoms

*Collaborate with patient, caregivers, and other health professionals


For the chapter in the Wells Handbook, please go to Chapter 67. Bipolar Disorder.



  • image Bipolar disorder is a cyclic mental illness with recurrent mood episodes that occur over a person’s lifetime. The symptoms, course, severity, and response to treatment differ among individuals.

  • image Bipolar disorder is likely caused by genetic factors, environmental triggers, and the dysregulation of neurotransmitters, neurohormones, and second messenger systems in the brain.

  • image Clinicians should obtain a detailed history, including potential substance use and medical illness, to avoid a delay in the diagnosis and treatment of bipolar disorder.

  • image The goal of therapy for bipolar disorder should be to improve patient functioning by reducing mood episodes. This is accomplished by maximizing adherence to therapy and limiting adverse effects.

  • image Patients and family members should be educated about bipolar disorder and treatments. Long-term monitoring and adherence to treatment are major factors in achieving stabilization of the disorder.

  • image Lithium and valproate are the mainstays of treatment for both acute mania and prophylaxis for recurrent manic and depressive episodes. Anticonvulsants (eg, lamotrigine, carbamazepine) and second-generation antipsychotics (eg, aripiprazole, quetiapine) are alternative or adjunctive treatments ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.