all patients with bipolar disorder should have an annual physical health review, normally in primary care, to ensure that the following are assessed each year:
lipid levels, including cholesterol in all patients over 40 even if there is no other indication of risk
plasma glucose levels
weight
smoking status and alcohol use
blood pressure
guidance for investigations in addition to annual checks described above:
thyroid function tests
for patients on lithium therapy - at start and every function 6 months; more often if evidence of deterioration
liver function tests
for patients on either valproate or carbamazepine - at start and at 6 months
renal function tests
for patients on lithium
at start and every 6 months; more often if there is evidence of deterioration or the patient starts taking drugs such ACE inhibitors, diuretics or NSAIDs
full blood count
if on lithium therapy - only if clinically indicated
if on either valproate or carbamazepine - at the start and at 6 months
blood glucose
if on antipsychotic therapy - at start and at 3 months (and at 1 month if taking olanzapine); more often if there is evidence of elevated levels
lipid profile
if on antipsychotic therapy - at start and at 3 months; more often if there is evidence of elevated levels
prolactin - if on risperidone then measure at start and if symptoms of hyperprolactinaemia develop
ECG - measure at start if on either antipsychotics or lithium if there are risk factors for or existing cardiovascular disease
weight
if on antipsychotic therapy - at start and every 3 months for first year; more often if the patient gains weight rapidly
if on lithium therapy - at start and when needed if the patient gains weight rapidly
if on valproate therapy - at start and at 6 months if the patient gains weight rapidly
if on carbamazepine therapy - at start and at 6 months if the patient gains weight rapidly
serum levels of drug
lithium - 1 week after initiation and 1 week after every dose change until levels stable, then every 3 months
valproate - Only if there is evidence of ineffectiveness, poor adherence or toxicity
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