Bipolar Disorder Clinic Visit Guidelines

Assessment and Evaluation

• A comprehensive bipolar disorder clinic visit should include assessment of mood changes, sleep patterns, psychomotor activity, suicidality, and medication adherence, with particular attention to distinct periods of mood alterations that represent a departure from baseline functioning 1
• Evaluate current mood state and changes since last visit, including distinct, spontaneous periods of mood changes, irritability, grandiosity or euphoria, and document duration of current mood episode (manic episodes ≥7 days, hypomanic episodes ≥4 days) 1
• Assess for changes in sleep requirements, insomnia or hypersomnia, fatigue or unusual bursts of energy, and psychomotor agitation or retardation 1, 2
• Evaluate ability to concentrate, decision-making capacity, impulsivity and risk-taking behaviors, interest in previously enjoyed activities, and school/work performance 2
• Always screen for current suicidal ideation, intent, or plan, recent suicide attempts, presence of agitation or hopelessness, and access to lethal means 2
• Review adherence to prescribed medications, side effects, effectiveness in controlling symptoms, and need for dosage adjustments 3
• Screen for alcohol and drug use, which can trigger or mimic mood episodes, and changes in substance use patterns since last visit 1, 3
• Assess family and social relationships, school/work functioning, and evidence of impairment across different life domains 1

Documentation and Longitudinal Perspective

• Use a life chart approach to document pattern of illness, duration of symptoms, treatment response, and psychosocial stressors 1
• This longitudinal perspective helps with diagnostic accuracy as presenting symptoms during acute phases can be confused with other disorders 1

Common Pitfalls to Avoid

• Misinterpreting irritability: Manic grandiosity and irritability present as marked changes in mental/emotional state, not merely reactions to situations or temperamental traits 1
• Overlooking comorbidities: Carefully evaluate for other associated problems including substance abuse, anxiety disorders, and medical conditions 1, 3
• Neglecting context: Emotional and behavioral difficulties are often context-dependent; assess symptom reports considering family, school, peer, and other psychosocial factors 1
• Underestimating suicide risk: Even in the absence of current suicidal ideation, continue to assess risk factors, especially in adolescents with bipolar disorder who have high rates of suicide attempts 2
• Missing mixed features: Be alert for simultaneous manic and depressive symptoms, which carry higher suicide risk 3