Treatment Plan

• If it’s suspected, refer using risk assessment to determine the urgency of the referral to secondary care. If a danger to themselves or others needs admission (need urgent mental health review +/- sectioning if needed)

• Medical management:

1. Acute Mania:

• First-line:

Quetiapine/risperidone/olanzapine/haloperidol
• Second line: Lithium
• Third line: Sodium valproate

2. Mixed Episodes:

• Treat as mania

3. Depressive Episodes:

• Quetiapine monotherapy
• Fluoxetine + olanzapine
• Olanzapine monotherapy
• Lamotrigine monotherapy

4. Long-term Management:

• Continue acute phase treatment for 4 weeks
• Consider lithium
• If lithium is ineffective: Add sodium valproate
• If lithium intolerant: Switch to sodium valproate/olanzapine
• High-intensity CBT
• Secondary care monitoring for 12 months
• Annual reviews thereafter in primary care