Bipolar disorders

Presentation and immediate needs

Bipolar assessment depends on distinct episodes of altered mood, energy and activity across a lifetime. A person may present with depression or between episodes.

Begin assessment → History, examination and context

History, examination and context

Construct an episode timeline with consented collateral. Distinguish reduced need for sleep from exhausted insomnia; establish observable changes in activity, judgment, spending, speech and functioning.

Consider the branch → Distinct elevated episode established by timeline and collateral?

Distinct elevated episode established by timeline and collateral?

Use clinical findings and collateral. Uncertainty needs clarification, not a default negative answer.

Yes / concerning features → Priority assessment; No / not established → Formulation and care discussion; Uncertain / not assessed → Obtain the missing information

Priority assessment

Clarify mania/hypomania, impairment and the lifetime course.

After appropriate assessment → Formulation and care discussion

Obtain the missing information

Review the examination, timeline, relevant investigations and consented collateral. Escalate urgent concerns while uncertainty is resolved.

Reassess the branch → Distinct elevated episode established by timeline and collateral?

Formulation and care discussion

Acute mania, bipolar depression and maintenance have different treatment aims. Discuss bipolar-specific options, psychological support, sleep and relapse planning. Medication selection requires reproductive, physical-health and monitoring context.

Agree follow-up → Reassess and follow up

Reassess and follow up

Track episode recurrence, sleep, function and adverse effects. Explain early warning signs and a jointly agreed route to review.