Page 2 - e-book QR - BIPOLAR DISORDER 2ND ED
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QUICK REFERENCE MANAGEMENT OF BIPOLAR DISORDER (2ND EDITION)
RISK FACTORS
KEY MESSAGES
Identifying risk factors may assist in the early detection of BD:
1. Bipolar Disorder (BD) is a potentially life-long condition presenting commonly as family history of BD
KEY MESSAGES dition presenting commonly as
1. Bipolar Disorder (BD) is a potentially life-long con
either bipolar I disorder (BD I) or bipolar II disorder (BD II). BD I is characterised
either bipolar I disorder (BD I) or bipolar II disorder (BD II). BD I is characterised offspring of maternal age group ≥40 years old
1. Bipolar Disorder (BD) is a potentially life-long condition presenting commonly as young age (<25 years old)
by episodes of mania, whilst BD II is characterised by episodes of hypomania and
by episodes of mania, whilst BD II is characterised by episodes of hypomania and
either bipolar I disorder (BD I) or bipolar II disorder (BD II). BD I is characterised
depressive episodes.
depressive episodes. presence of major depression with attention-deficit hyperactivity disorder (ADHD)
low educational level
by episodes of mania, whilst BD II is characterised by episodes of hypomania and
2. BD should be diagnosed based on the Diagnostic and Statistical Manual of Mental
2. BD should be diagnosed based on the Diagnostic and Statistical Manual of Mental low employment level
depressive episodes.
Disorders Fifth Edition, Text Revision (DSM-5-TR) or International Classification
Disorders Fifth Edition, Text Revision (DSM-5-TR) or International Classification of
2. BD should be diagnosed based on the Diagnostic and Statistical Manual of Mental DIFFERENTIAL DIAGNOSIS
of Diseases Eleventh Revision (ICD-11).
Diseases Eleventh Revision (ICD-11).
Disorders Fifth Edition, Text Revision (DSM-5-TR) or International Classification
3. Antipsychotics (APs) or mood stabilisers, either as monotherapy or combination,
3. Antipsychotics (APs) or mood stabilisers, either as monotherapy or combination, Common differential diagnoses to be considered:
of Diseases Eleventh Revision (ICD-11).
should be used to treat acute mood episodes (mania, depressive and mixed
should be used to treat acute episodes of mania/depression & as maintenance
3. Antipsychotics (APs) or mood stabilisers, either as monotherapy or combination, a) during depressive episode -
episodes) & as maintenance therapy in BD.
major depressive disorder
therapy in BD; and may be used in mixed features.
should be used to treat acute mood episodes (mania, depressive and mixed
4. For BD with anxious distress, AAPs may be used. major depressive disorder with mixed episode
4. For BD with anxious distress, AAPs may be used. adjustment disorder with depressed mood
episodes) & as maintenance therapy in BD.
5. For BD with rapid cycling, a combination of mood stabilisers with AAPs or another
4. For BD with anxious distress, AAPs may be used.
5. For BD with rapid cycling, a combination of mood stabilisers with AAPs or another anxiety disorder
mood stabiliser is the preferred treatment of choice.
5. For BD with rapid cycling, a combination of mood stabilisers with AAPs or another
mood stabiliser is the preferred treatment of choice.
6. Antidepressants (AD) may be used as short-term adjunctive treatment but not as depressive disorder due to another medical condition
substance-induced depressive disorder
mood stabiliser is the preferred treatment of choice.
6. Antidepressants (AD) may be used as short-term adjunctive treatment but not as schizophrenia or schizoaffective disorder
monotherapy in BD. It should be avoided in mixed episodes & used with caution
6. Antidepressants (AD) may be used as short-term adjunctive treatment but not as
monotherapy in BD. It should be avoided in mixed episodes & used with caution
in rapid cycling BD.
monotherapy in BD. It should be avoided in mixed episodes & used with caution
7. Long-acting AAP b) during mania or hypomania episode -
in rapid cycling BD. injectables may be considered in BD patients who have poor
in rapid cycling BD.
adherence to oral medications.
7. Long-acting AAP injectables may be considered in BD patients who have poor substance-induced bipolar disorder
bipolar & related disorder due to another medical condition
7. Long-acting AAP injectables may be considered in BD patients who have poor
8. Electroconvulsive therapy should be considered in both bipolar manic & schizophrenia or schizoaffective disorder
adherence to oral medications.
adherence to oral medications.
depressive episodes in indicated situations (refer to Algorithm 1 & 2).
8. Electroconvulsive therapy should be considered in both bipolar manic & depressive borderline personality disorder
8. Electroconvulsive therapy should be considered in both bipolar manic &
9. Psychosocial interventions & psychotherapies should be offered as an adjunctive ADHD
episodes in indicated situations (refer to Algorithm 1 & 2).
depressive episodes in indicated situations (refer to Algorithm 1 & 2).
treatment for BD especially in relapse prevention.
9. Psychosocial interventions & psychotherapies should be offered as an adjunctive
9. Psychosocial interventions & psychotherapies should be offered as an adjunctive CO-MORBIDITIES
10. Shared decision-making in weighing risks vs benefits of pharmacological
treatment for BD especially in relapse prevention.
treatment for BD especially in relapse prevention.
treatment should be done in pregnant & lactating women with BD. Psychiatric co-morbidities include:
10. Shared decision-making in weighing risks vs benefits of pharmacological
10. Shared decision-making in weighing risks vs benefits of pharmacological treatment drug abuse
treatment should be done in pregnant & lactating women with BD. anxiety disorder
should be done in pregnant & lactating women with BD.
This Quick Reference provides key messages & a summary of the main recommendations borderline personality disorder
in the Clinical Practice Guidelines (CPG) Management of Bipolar Disorder (Second Edition). ADHD
This Quick Reference provides key messages & a summary of the main recommendations anti-social personality disorder
Details of the evidence supporting these recommendations can be found in the above
in the Clinical Practice Guidelines (CPG) Management of Bipolar Disorder (Second Edition). eating disorder
CPG, available on the following websites:
Details of the evidence supporting these recommendations can be found in the above REFERRAL CRITERIA
Ministry of Health Malaysia: www.moh.gov.my
CPG, available on the following websites:
Academy of Medicine Malaysia: www.acadmed.org.my
Malaysian Psychiatric Association: www.psychiatry-malaysia.org BD can be managed in primary care EXCEPT in the following conditions:
Ministry of Health Malaysia: www.moh.gov.my
Academy of Medicine Malaysia: www.acadmed.org.my unsure of diagnosis intolerable or medically important adverse events of
Malaysian Psychiatric Association: www.psychiatry-malaysia.org complex presentation of mood episodes medication
CLINICAL PRACTICE GUIDELINES SECRETARIAT
Malaysian Health Technology Assessment Section (MaHTAS) acute exacerbation of symptoms psychiatric co-morbidities
Medical Development Division, Ministry of Health Malaysia increased risk of harm to self or others psychotherapeutic needs
CLINICAL PRACTICE GUIDELINES SECRETARIAT
Level 4, Block E1, Precinct 1
Malaysian Health Technology Assessment Section (MaHTAS) marked impairment in social or ambivalent or wanting to stop any medication after a
period of relatively stable mood
occupational functioning
Federal Government Administrative Centre 62590
Medical Development Division, Ministry of Health Malaysia
Putrajaya, Malaysia
Level 4, Block E1, Precinct 1 poor or partial response to treatment special population -
Tel: 603-88831229
Federal Government Administrative Centre 62590 poor treatment adherence o pregnant or planning a pregnancy
E-mail: htamalaysia@moh.gov.my o children & adolescents
Putrajaya, Malaysia
Tel: 603-88831229 o co-morbidity with alcohol or substance misuse
E-mail: htamalaysia@moh.gov.my
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