Table 5.

Principles of providing care for patients with BD

Prepare		Provide psychiatric	Provide medical	Provide support
the practice	Diagnose BD	treatment	treatment	and counseling
Define level of management to be assumed by practice. Obtain agreement of clinical staff. Train staff. Set up systems for followup, monitoring, and recall. Contact referral and support services for mania and suicidality and pharmacologic expertise. Develop crisis response strategies. Prepare compendium of web resources.	Screen for depression. Screen for BD and psychiatric comorbidities in those positive on depression screening. Obtain family and social history. Consult guidelines.	Establish treatment goals and therapeutic alliance. Link with psychiatric and community colleagues for referrals. Provide education to patients and their families about the disorder and its treatments, including treatment adherence. Initiate followup, monitoring. Collaborate with psychiatric clinician as necessary.	Check for medical comorbidities (e.g., cardiovascular problems, lipid abnormalities, diabetes). Treat medical comorbidities aggressively. Monitor for psychotropic medication side effects. Collaborate with specialists as necessary.	Instruct in self‐monitoring and response to prodromal symptoms. Provide support through transitions. Improve problem‐solving skills. Facilitate connection to support groups, online support, and so on.

Red flags indicating need for specialist involvement:

▪ Suicidality

▪ Pregnancy and postpartum

▪ Severe psychiatric comorbidity (e.g., substance dependence, anxiety)

▪ History of treatment resistance (e.g., multiple hospitalizations)

▪ Rapid‐cycling pattern.

Adapted from Culpepper (2010).