GuidelinesPrimary Care STG
Bipolar Disorder
Mood
ICD-10 code: F30.0-F30.2/F30.8-F30.9/F31.0-9/F38.0-1/F38.8/F39 + (F10.0-F19.9/R45.0-8/Z65.0-5/Z65.8- 9/Z81.0-4/Z81.8)
Description
A lifelong illness which may have an episodic, variable course with the presenting episode being manic, hypomanic, mixed, or depressive (according to accepted diagnostic criteria). An episode of mania is typically characterised by an elevated mood where a patient may experience extreme happiness, lasting days to weeks, which might also be associated with an underlying irritability. Such mood is associated with increased energy/activity, talkativeness, and a reduction in the need for sleep, and features may be accompanied by grandiose and/or religious delusions.
The diagnosis of bipolar disorder should be confirmed by a specialist. It may present with any mood state, e.g. with treatment resistant depression. The diagnosis requires either a current or previous episode of mania (bipolar I disorder) or hypomania (bipolar II disorder), but this history is not always clear, in which case a trial of treatment may be indicated.
Comorbid substance use is common. It may confuse the clinical presentation and may cause poor adherence to medication. The ‘dual diagnosis’ of bipolar disorder and an addiction requires referral to a specialist and ongoing monitoring after discharge.
General Measures
- Provide reassurance and support of the patient and family.
- Psychoeducate regarding the nature of bipolar disorder, the importance of treatment adherence, and early signs of recurrent episodes.
Medicine Treatment
For manic, agitated, and acutely disturbed patients:
- Stop antidepressants if prescribed.
- Manage as for the aggressive or disruptive patient. See: Aggressive disruptive behaviour in adults and Aggressive disruptive behaviour in children and adolescents.
For stable patients:
- Support treatment adherence and manage comorbid medical conditions - See: Psychiatric patients - general monitoring and care.
Referral
- All patients
Standard Treatment Guidelines and Essential Medicines List for South Africa Primary Healthcare Level_Chapter 16: Mental Health Conditions_NEMLC Recommendations for Medicine Amendments 2020_2023
ICD-10 codes
- F10.0Mental and behavioural disorders due to use of alcohol, acute intoxication
- F10.1Mental and behavioural disorders due to use of alcohol, harmful use
- F10.2Mental and behavioural disorders due to use of alcohol, dependence syndrome
- F10.3Mental and behavioural disorders due to use of alcohol, withdrawal state
- F10.4Mental and behavioural disorders due to use of alcohol, withdrawal state with delirium
- F10.5Mental and behavioural disorders due to use of alcohol, psychotic disorder
- F10.6Mental and behavioural disorders due to use of alcohol, amnesic syndrome
- F10.7Mental and behavioural disorders due to use of alcohol, residual and late-onset psychotic disorder
- F10.8Mental and behavioural disorders due to use of alcohol, other mental and behavioural disorders
- F10.9Mental and behavioural disorders due to use of alcohol, unspecified mental and behavioural disorder
- F11.0Mental and behavioural disorders due to use of opioids, acute intoxication
- F11.1Mental and behavioural disorders due to use of opioids, harmful use
- F11.2Mental and behavioural disorders due to use of opioids, dependence syndrome
- F11.3Mental and behavioural disorders due to use of opioids, withdrawal state
- F11.4Mental and behavioural disorders due to use of opioids, withdrawal state with delirium
- F11.5Mental and behavioural disorders due to use of opioids, psychotic disorder
- F11.6Mental and behavioural disorders due to use of opioids, amnesic syndrome
- F11.7Mental and behavioural disorders due to use of opioids, residual and late-onset psychotic disorder
- F11.8Mental and behavioural disorders due to use of opioids, other mental and behavioural disorders
- F11.9Mental and behavioural disorders due to use of opioids, unspecified mental and behavioural disorder
- F12.0Mental and behavioural disorders due to use of cannabinoids, acute intoxication
- F12.1Mental and behavioural disorders due to use of cannabinoids, harmful use
- F12.2Mental and behavioural disorders due to use of cannabinoids, dependence syndrome
- F12.3Mental and behavioural disorders due to use of cannabinoids, withdrawal state
- F12.4Mental and behavioural disorders due to use of cannabinoids, withdrawal state with delirium
- F12.5Mental and behavioural disorders due to use of cannabinoids, psychotic disorder
- F12.6Mental and behavioural disorders due to use of cannabionoids, amnesic syndrome
- F12.7Mental and behavioural disorders due to use of cannabinoids, residual and late-onset psychotic disorder
- F12.8Mental and behavioural disorders due to use of cannabinoids, other mental and behavioural disorders
- F12.9Mental and behavioural disorders due to use of cannabinoids, unspecified mental and behavioural disorder
- F13.0Mental and behavioural disorders due to use of sedatives or hypnotics, acute intoxication
- F13.1Mental and behavioural disorders due to use of sedatives or hypnotics, harmful use
- F13.2Mental and behavioural disorders due to use of sedatives or hypnotics, dependence syndrome
- F13.3Mental and behavioural disorders due to use of sedatives or hypnotics, withdrawal state
- F13.4Mental and behavioural disorders due to use of sedatives or hypnotics, withdrawal state with delirium
- F13.5Mental and behavioural disorders due to use of sedatives or hypnotics, psychotic disorder
- F13.6Mental and behavioural disorders due to use of sedatives or hypnotics, amnesic syndrome
- F13.7Mental and behavioural disorders due to use of sedatives or hypnotics, residual and late-onset psychotic disorder
- F13.8Mental and behavioural disorders due to use of sedatives or hypnotics, other mental and behavioural disorders
- F13.9Mental and behavioural disorders due to use of sedatives or hypnotics, unspecified mental and behavioural disorder
- F14.0Mental and behavioural disorders due to use of cocaine, acute intoxication
- F14.1Mental and behavioural disorders due to use of cocaine, harmful use
- F14.2Mental and behavioural disorders due to use of cocaine, dependence syndrome
- F14.3Mental and behavioural disorders due to use of cocaine, withdrawal state
- F14.4Mental and behavioural disorders due to use of cocaine, withdrawal state with delirium
- F14.5Mental and behavioural disorders due to use of cocaine, psychotic disorder
- F14.6Mental and behavioural disorders due to use of cocaine, amnesic syndrome
- F14.7Mental and behavioural disorders due to use of cocaine, residual and late-onset psychotic disorder
- F14.8Mental and behavioural disorders due to use of cocaine, other mental and behavioural disorders
- F14.9Mental and behavioural disorders due to use of cocaine, unspecified mental and behavioural disorder
- F15.0Mental and behavioural disorders due to use of other stimulants, including caffeine, acute intoxication
- F15.1Mental and behavioural disorders due to use of other stimulants, including caffeine, harmful use
- F15.2Mental and behavioural disorders due to use of other stimulants, including caffeine, dependence syndrome
- F15.3Mental and behavioural disorders due to use of other stimulants, including caffeine, withdrawal state
- F15.4Mental and behavioural disorders due to use of other stimulants, including caffeine, withdrawal state with delirium
- F15.5Mental and behavioural disorders due to use of other stimulants, including caffeine, psychotic disorder
- F15.6Mental and behavioural disorders due to use of other stimulants, including caffeine, amnesic syndrome
- F15.7Mental and behavioural disorders due to use of other stimulants, including caffeine, residual and late-onset psychotic disorder
- F15.8Mental and behavioural disorders due to use of other stimulants, including caffeine, other mental and behavioural disorders
- F15.9Mental and behavioural disorders due to use of other stimulants, including caffeine, unspecified mental and behavioural disorder
- F16.0Mental and behavioural disorders due to use of hallucinogens, acute intoxication
- F16.1Mental and behavioural disorders due to use of hallucinogens, harmful use
- F16.2Mental and behavioural disorders due to use of hallucinogens, dependence syndrome
- F16.3Mental and behavioural disorders due to use of hallucinogens, withdrawal state
- F16.4Mental and behavioural disorders due to use of hallucinogens, withdrawal state with delirium
- F16.5Mental and behavioural disorders due to use of hallucinogens, psychotic disorder
- F16.6Mental and behavioural disorders due to use of hallucinogens, amnesic syndrome
- F16.7Mental and behavioural disorders due to use of hallucinogens, residual and late-onset psychotic disorder
- F16.8Mental and behavioural disorders due to use of hallucinogens, other mental and behavioural disorders
- F16.9Mental and behavioural disorders due to use of hallucinogens, unspecified mental and behavioural disorder
- F17.0Mental and behavioural disorders due to use of tobacco, acute intoxication
- F17.1Mental and behavioural disorders due to use of tobacco, harmful use
- F17.2Mental and behavioural disorders due to use of tobacco, dependence syndrome
- F17.3Mental and behavioural disorders due to use of tobacco, withdrawal state
- F17.4Mental and behavioural disorders due to use of tobacco, withdrawal state with delirium
- F17.5Mental and behavioural disorders due to use of tobacco, psychotic disorder
- F17.6Mental and behavioural disorders due to use of tobacco, amnesic syndrome
- F17.7Mental and behavioural disorders due to use of tobacco, residual and late-onset psychotic disorder
- F17.8Mental and behavioural disorders due to use of tobacco, other mental and behavioural disorders
- F17.9Mental and behavioural disorders due to use of tobacco, unspecified mental and behavioural disorder
- F18.0Mental and behavioural disorders due to use of volatile solvents, acute intoxication
- F18.1Mental and behavioural disorders due to use of volatile solvents, harmful use
- F18.2Mental and behavioural disorders due to use of volatile solvents, dependence syndrome
- F18.3Mental and behavioural disorders due to use of volatile solvents, withdrawal state
- F18.4Mental and behavioural disorders due to use of volatile solvents, withdrawal state with delirium
- F18.5Mental and behavioural disorders due to use of volatile solvents, psychotic disorder
- F18.6Mental and behavioural disorders due to use of volatile solvents, amnesic syndrome
- F18.7Mental and behavioural disorders due to use of volatile solvents, residual and late-onset psychotic disorder
- F18.8Mental and behavioural disorders due to use of volatile solvents, other mental and behavioural disorders
- F18.9Mental and behavioural disorders due to use of volatile solvents, unspecified mental and behavioural disorder
- F19.0Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, acute intoxication
- F19.1Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, harmful use
- F19.2Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, dependence syndrome
- F19.3Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, withdrawal state
- F19.4Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, withdrawal state with delirium
- F19.5Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, other psychotic disorder
- F19.6Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, amnesic syndrome
- F19.7Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, residual and late-onset other psychotic disorder
- F19.8Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, other mental and behavioural disorders
- F19.9Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, unspecified mental and behavioural disorder
- F30.0Hypomania
- F30.1Mania without psychotic symptoms
- F30.2Mania with psychotic symptoms
- F30.8Other manic episodes
- F30.9Manic episode, unspecified
- F31.0Bipolar affective disorder, current episode hypomanic
- F31.1Bipolar affective disorder, current episode manic without psychotic symptoms
- F31.2Bipolar affective disorder, current episode manic with psychotic symptoms
- F31.3Bipolar affective disorder, current episode mild or moderate depression
- F31.4Bipolar affective disorder, current episode severe depression without psychotic symptoms
- F31.5Bipolar affective disorder, current episode severe depression with psychotic symptoms
- F31.6Bipolar affective disorder, current episode mixed
- F31.7Bipolar affective disorder, currently in remission
- F31.8Other bipolar affective disorders
- F31.9Bipolar affective disorder, unspecified
- F38.0Other single mood [affective] disorders
- F38.1Other recurrent mood [affective] disorders
- F38.8Other specified mood [affective] disorders
- F39Unspecified mood [affective] disorder
- R45.0Nervousness
- R45.1Restlessness and agitation
- R45.2Unhappiness
- R45.3Demoralization and apathy
- R45.4Irritability and anger
- R45.5Hostility
- R45.6Physical violence
- R45.7State of emotional shock and stress, unspecified
- R45.8Other symptoms and signs involving emotional state
- Z65.0Conviction in civil and criminal proceedings without imprisonment
- Z65.1Imprisonment and other incarceration
- Z65.2Problems related to release from prison
- Z65.3Problems related to other legal circumstances
- Z65.4Victim of crime and terrorism
- Z65.5Exposure to disaster, war and other hostilities
- Z65.8Other specified problems related to psychosocial circumstances
- Z81.0Family history of mental retardation
- Z81.1Family history of alcohol abuse
- Z81.2Family history of tobacco abuse
- Z81.3Family history of other psychoactive substance abuse
- Z81.4Family history of other substance abuse
- Z81.8Family history of other mental and behavioural disorders