main post one page single spaced B u s i n e s s F i n a n c e

main post one page single spaced B u s i n e s s F i n a n c e



1) Discussion Board 4

Review the Bipolar treatment guidelines (APA, VA/DoD, NICE) and compare the recommendations. Which guidelines do you find most useful? Why?

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Read your peers´ posts and respond to at least two of your peers. Compare your answer to that of your classmates and create engaging dialog based on both. Your response should include evidence of review of the course material through proper citations using APA format.

1) response to post 1post ( Alessandra B)

Bipolar Treatment Guidelines

The VA/DoD clinical practice guidelines for the treatment of adults with bipolar disorder have an easy to read layout. The target population is patients ages 18 and over, and the guidelines are separated out into modules, including one specifically for the older adult. Similar to the VA/DoD guidelines for depression, each module starts out with a detailed flow chart on how to treat a patient in an acute mania or mixed bipolar episode, a depressive bipolar episode, and the maintenance phase. Also of benefit to prescribers is a table listing the most effective medication options with evidence based reasoning. For example, in patients experiencing mania or a mixed episode of BD, the medications Gabapentin, Lamictal, and Topamax have been found to cause unnecessary side effects while failing to show efficacy in recent studies. Module D discussed psychoeducation and psychotherapy options, while Module E discussed the medication options for BD in more detail, including side effects and drug- drug interactions (VA/DoD, 2010).

The APA also has guidelines for providers treating patients for bipolar disorder. Differing from the VA/DoD guidelines, the APAs are broken down into sections first discussing each form of bipolar disorder, then formulating a treatment plan. All types are included in each section in paragraph format rather than separating into mania/mixed/depressive episodes. They also included treatment options for rapid cycling bipolar and a section on clinical features that may influence the treatment plan, such as patients who struggle with substance use disorders or present in a catatonic state. For example, patients with catatonia generally have poor outcomes. Research shows that neuroleptic medications have poor efficacy in treatment, whereas lorazepam and ECT should be considered first line in these patients. Another beneficial section for prescribers targeted research on psychosocial factors, such as treatment around pregnancy, or in the adolescent and childhood populations. This differed from the VA/DoD guidelines as this information was not included. The second half of the guidelines focused on the background and research around each recommendation, which was presented in a very detailed fashion. Finally, the guidelines concluded with areas that were lacking research at the time of the review, with recommendations on where future research may be needed (APA, 2002).

Different from both the previous guidelines discussed, the National Institute for Health and Care Excellence (NICE) guidelines focus on children and adolescent patients as well as the adult and older adult populations. While these guidelines are less detailed in general, there are multiple links leading you to see other recommendations for each section. It was beneficial to see be able to scroll to exactly what you’re looking for and click on the link, rather than search through an entire detailed document in more of a paragraph format. For example, in the pharmacotherapy section, you are able to click a link detailing the more current recommendations around risks of prescribing valproate to female patients of childbearing age, and what your practice needs to have in place prior to doing so (NICE, 2020).

I think all of the guidelines have their benefits or downfalls, but overall my favorite was the VA/DoD guidelines. I felt these were the quickest and easiest to navigate. I liked the algorithms and the tables to help break up the information. As someone who will be new to treating bipolar disorder, but not new to prescribing in general, I think this format has the most benefit for me. The APA guidelines were very detailed, but because of this the document was a little lengthy and not something that could be used as a quick reference guide in the office. The NICE guidelines were also user friendly as a website, and much more brief, but required following links in order to get more information around some of the recommendations.


American Psychiatric Association practice guidelines for the treatment of psychiatric disorders. (2002). Washington, D.C.: The Association. Retrieved October 06, 2020, from

NICE. (2020, February 11). Overview: Bipolar disorder: Assessment and management: Guidance. Retrieved October 06, 2020, from

Bipolar disorder (BD) is a chronic disorder including recurrent depressive, manic, hypomanic episodes, or mood episodes with mixed features, which negatively affect the social and occupational function of an individual (WangI, Zhang, Yao, Ding, Jiang, & Wu, 2020). It is labeled as the sixth leading cause of disability worldwide. BD treatment using antipsychotics (AP) or mood stabilizers produced unhealthy result (Kocakaya, Songur, Batmaz, Elikbas, & Kucukk, 2020). It has been proven by studies lifestyle factors common in patients with BD consisting of high-calorie dietary intake, smoking, and physical inactivity. These behaviors lead to increased risk for obesity, dyslipidemia, diabetes mellitus, and metabolic syndrome (MS). Hence, to eradicate these issues and to treat BD appropriately without creating other health issues. BD treatment guidelines were established by several organizations to assist clinicians to treat patients appropriately to enhance individuals’ health. APA, VA/DoD, NICE has guidelines to treat BD to enhance the affected patients’ health. The three guidelines have some similarities and differences. However, they all work critically to promote patients’ health.

VA, the Department of Veterans, established guidelines for Bipolar treatment Affairs (VA) and The Department of Defense (DoD) to provide information and assist in decision-making regarding BD treatment (Department of Veterans Affairs and Department of Defense, 2010). The VA guidelines focused is on the adult population from 18 years and older with bipolar. It also targets all BD episodes, including mania, hypomania, depression, and mixed episodes. The guideline addresses patients with BD and comorbidities as well as pregnant women and adults with cognitive impairments. In the Mania episode, the initial medication is lithium, valproate, carbamazepine, aripiprazole, olanzapine, quetiapine, risperidone, or ziprasidone. In Mixed episodes, the guideline is to start patients with valproate, carbamazepine, olanzapine, aripiprazole, risperidone, or ziprasidone (Department of Veterans Affairs and Department of Defense, 2010).

NICE guidelines for Bipolar Disorder treatment is a National Clinical Guideline to assist clinicians and service users in making critical decisions in prescribing appropriate treatment for patients with Bipolar disorder (The British Psychological Society and The Royal College of Psychiatrists, 2014). The guideline also addresses the episodes of Bipolar disorder such as depression, Mania and hypomania, and mixed states. The guidelines address the diagnosis and do proper assessment methods, including. Unlike VA/DOoD guidelines, the NICE focuses on both children and the adult population. The guidelines define each medication and laboratory to monitor for in the course of prescription. The guidelines also address non-pharmacological treatment for acute episodes, including acupuncture, bright light therapy, transcranial magnetic stimulation, and vagus nerve stimulation (The British Psychological Society and The Royal College of Psychiatrists, 2014).

APA the guideline is another bipolar treatment guidelines which address demographic and psychosocial factors such as gender, pregnancy, Cross-cultural issues, and, geriatric, children/adult of patients with the disorder and provide information on how to address individual (American Psychiatric Association, 2010). Lithium is noted as the initial medication to treat somatic treatments of acute manic and mixed episodes.

Compare the recommendations. Which guidelines do you find most useful? Why

The three guidelines are unique in their own way. However, they all have similarities, such as promoting lithium as the initially prescribed medication in treating bipolar disorder. Each of them also addresses the different bipolar disorder episodes and addresses each type, such as mania, depression, and mixed. However, there are some differences between these three guidelines. VA/DoD guidelines only focus on the adult population from 18 years old, which is biased because it does not address children with the disorder. Hence, I prefer the APA guidelines since it addresses all ages, gender, and cultures, which promote holistic care.


American Psychiatric Association. (2010). Practice guideline for the treatment of patients with bipolar disorder. Retrieved October 7, 2020, from,patient%20and%20are%20subject%20to%20change%20as%20sci-

Department of Veterans Affairs and Department of Defense. (2010). VA/DoD clinical practice guideline for the management of bipolar disorder in adults. Retrieved October 7, 2020, from