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Physical health check and laboratory monitoring for patients with bipolar disorder

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • 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.

 

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