Referral criteria from primary care - bipolar disorder

With respect to adults with bipolar disorder:

• if new or suspected bipolar disorder:
  • when adults present in primary care with depression, ask about previous periods of overactivity or disinhibited behaviour. If the overactivity or disinhibited behaviour lasted for 4 days or more, consider referral for a specialist mental health assessment
  • refer people urgently for a specialist mental health assessment if mania or severe depression is suspected or they are a danger to themselves or others.
  • ask about hypomanic symptoms when assessing a patient with depression and overactive, disinhibited behaviour
    
    
• patients with existing bipolar disorder:
  • refer urgently a patient with bipolar disorder if there is:
    • an acute exacerbation of symptoms - particularly mania or severe depression
    • an increase in the degree (or change in the nature) of risk to self or others
      
      
  • if bipolar disorder is managed solely in primary care, re-refer to secondary care if any one of the following applies:
    • there is a poor or partial response to treatment
    • the person's functioning declines significantly
    • treatment adherence is poor
    • the person develops intolerable or medically important side effects from medication
    • comorbid alcohol or drug misuse is suspected
    • the person is considering stopping any medication after a period of relatively stable mood
    • a woman with bipolar disorder is pregnant or planning a pregnancy

Reference:

1. NICE (July 2006). Bipolar disorder
2. NICE (April 2018). Bipolar disorder