23. Bipolar affective disorder


   

In this series featuring information for patients and professionals taken from SIGN’s evidence-based guidelines we reproduce the information for discussion with patients and carers from SIGN guideline number 82, on bipolar affective disorder.

To broaden the base of patient and carers’* involvement in the development of the guideline a meeting was held with seven patients and six carers from different Scottish regions. The following points summarise the issues that they found important at the different stages of their care.

This list is by no means complete, or unbiased, but it may help to guide the development and improvement of local information materials and protocols. The guideline also provides sources of further information and support for patients and carers (see Box 1 and Box 2 below).

Box 1: National telephone helplines

Breathing Space
Tel: 0800 83 85 87
Website: www.breathingspacescotland.org.uk
A free, confidential phone-line for men.The phone-line is open from early evening to 2 am. Breathing Space advisors can offer advice and suggest local people who can help with specific problems. Calls do not appear on the phone bill.

Samaritans
Tel: 08457 90 90 90
Website: www.samaritans.org.uk
Available 24 hours a day to provide confidential emotional support for people who are experiencing feelings of distress or despair.

Saneline
Tel: 08457 67 80 00
Website: www.sane.org.uk

Adapted from SIGN 82. Bipolar affective disorder. Edinburgh: Scottish Intercollegiate Guidelines Network, 2005.
Box 2: Sources of further information for patients and carers
Bipolar Fellowship Scotland
Studio 1016, Mile End Mill, Abbey Mill Business Centre, Seedhill Road, Paisley PA1 1TJ Tel: 0141 560 2050 Website: www.bipolarscotland.org.uk
Provides information and advice to anyone with an interest in bipolar affective disorder. Network of self help groups throughout Scotland.
CarersNet
Website: www.carers.net
The official website of the Coalition of Carers in Scotland – an information network designed for carers, carer groups and organisations, and for people working with carers.
Carers Online
Website: www.carersonline.org.uk
A partnership website that provides carers, those supporting them and others with national and local information.
Depression Alliance
Scotland 3 Grosvenor Gardens, Edinburgh EH12 5JU Tel: 0131 467 3050
Website: www.depressionalliance.org
Information and support for people in Scotland with depression.
Driver and Vehicle Licensing Agency (DVLA) Medical Rules
Website: www.dvla.gov.uk/drivers/dmed1.htm
Highland User Group Highland Community Care Forum
Highland House, 20 Longman Road, Inverness IV1 1RY Tel: 01464 718817
Website: www.hug.uk.net
MDF – The Bipolar Organisation
UK Head Office, Castle Works, 21 St George’s Road, London SE1 6ES Tel: 0845 340 540
Website: www.mdf.org.uk
Information and support for people with bipolar affective disorder in the UK. Runs self management training and has a comprehensive range of publications on a range of topics, including a guide to medications.
National Schizophrenia Fellowship (Scotland)
Claremont House, 130 East Claremont Street, Edinburgh EH7 4LB Tel: 0131 557 8969
Website: www.nsfscot.org.uk
Information and support on severe mental health problems, especially schizophrenia. Offers support to carers, and has many services across Scotland. Provides a leaflet entitled "Mental illness in your family” which includes a section on bipolar disorder.
Scottish Association for Mental Health (SAMH)
Cumbrae House, 15 Carlton Court, Glasgow G5 9JP Tel: 0141 568 7000
Email: enquire@samh.org.uk Website: www.samh.org.uk
Information and advice on all aspects of mental health, Monday to Friday 2 - 4.30 pm.
'see me'
Tel: 0131 624 8945 Website: www.seemescotland.org
National campaign highlighting, and fighting, the stigma of mental ill health. Encourages people to tell their stories of stigma, monitors and responds to episodes of stigma and links anti-stigma work Scotland wide.
Youngminds
Website: www.youngminds.org.uk
Provides a leaflet entitled "Mental illness in your family” which includes a section on bipolar disorder.
Adapted from SIGN 82. Bipolar affective disorder. Edinburgh: Scottish Intercollegiate Guidelines Network, 2005.

Diagnosis

Patients and carers appreciated:

  • A clear explanation of the time and complexity involved in making a diagnosis of bipolar affective disorder
  • Information about the non-medical implications of bipolar affective disorder, for example, effects on occupation and other aspects of patients’ personal life (e.g. driving).

Patients would like:

  • Active involvement in the diagnostic process
  • Information on symptoms and possible treatment options (in a format tailored to the individual patient)
  • This may require more time for consultations or even discussion sessions, the opportunity to meet with health professionals, especially after being detained, and clear written information to back up verbal information.

Carers like:

  • To be involved in the diagnostic process
  • To be given information on what to do when their relative/friend is ill for the first time
  • Practical information about risk prevention and advice on legal issues.

General points:

  • Both patients and carers felt that increased awareness of bipolar affective disorder and its symptoms was needed amongst health professionals
  • They felt that a reduction in stigma of the diagnosis, would encourage acceptance and more effective self management.

Treatment

Patients and carers appreciated:

  • The ‘excellent’ support they received from voluntary sector agencies and from community psychiatric nurses (CPNs).

Patients would like more:

  • Information from GPs
  • Improved information-giving by hospital psychiatrists and other medical members of staff
  • Information on legal and social/economic aspects of treatment
  • More information on medication (before and after prescription) including side-effects of treatment
  • Information on the effects of possible contraindications to over-the-counter medications (e.g. cold and flu remedies), alcohol and illegal drugs
  • Support in ‘managing’ medication levels after recovery
  • Information on and access to psychological therapies, complementary therapies and local support
  • Advice on how to complement medical treatment with lifestyle choices and make compromises
  • Advice on keeping mood charts, signs to look out for, information on blood monitoring, driving restrictions, travel insurance, ‘triggers’ to watch out for, long term consequences of treatment
  • Information on Advance Statements
  • Information on hospital discharge arrangements, local support agencies and emergency contact information.

Carers wanted:

  • More information on patient choice, the pros and cons of treatment options and the expected lengths of treatment
  • Information on lithium withdrawal and relapse
  • Information on advocacy, data protection issues and human rights
  • To continue to be involved in treatment plans
  • Advice on how to communicate with other family members
  • Advice on how to recognise early signs of relapse and avoid stressful ‘triggers’ in everyday life.

General points:

  • The use of Advance Statements with people with bipolar disorders should be actively promoted as a means of improving self insight, strengthening and defining the doctor-patient relationship and facilitating the least restrictive alternative in compulsory treatment
  • Users and carers should be truly involved in decision making processes in relation to their own care and treatment options
  • Patients require timely and efficient access to the most appropriate service at any given time e.g. crisis services, inpatient facilities, psychological services and other voluntary sector support services
  • Greater availability of respite care facilities
  • Increased availability of life skills coaching to facilitate maximum participation, inclusion and productivity when well
  • Better awareness on side-effects and toxicity awareness, for patients and GPs. Included in this is the need for users and carers to be aware of the importance of regular blood checks if required
  • Patients should be involved, where possible, in discussions on treatment options, introducing the element of choice and informed decision making.

Reproduced from SIGN 82. Bipolar affective disorder. Edinburgh: Scottish Intercollegiate Guidelines Network, 2005.

Guidelines in Practice, July 2005, Volume 8(7)
© 2005 MGP Ltd
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