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In the patient who is manic

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Mania: When to refer to a specialist

The primary care provider should refer to a specialist in the following situations:

  • a patient requiring hospital admission
  • questions regarding capacity for treatment decisions
  • unfamiliarity with the use of anti-bipolar medications
  • complex and uncertain clinical presentations
  • diagnostic dilemmas
  • cases of treatment-resistant mania
  • problematic adverse events and safety concerns with medication
  • when considering electroconvulsive therapy
Adapted from: Roger McIntyre, The patient who is manic,  Psychiatry in Primary Care (CAMH, 2011)

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Frequently asked questions

Clinical guidelines

Canadian network for Mood and Anxiety Treatment (CANMAT) guidelines for the management of patients with bipolar disorder (2005, updated 2009, 2013)

Bipolar disorder: Assessment and management (NICE guideline CG185, 2014)