Physical health check and laboratory monitoring for patients with bipolar disorder

• 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
    • carbamazepine - every 6 months

Reference:

1. NICE (July 2006). Bipolar disorder.