Explain bipolar I diagnosis and lithium plan — CASC communication station

Open and agenda-set. Name time available; ask main worries (kidneys, personality, work, suicide). Include partner with consent. [4]

Explain diagnosis. “Bipolar I means you have had a manic episode — a period of pathologically high energy and mood with little need for sleep and risky decisions lasting days and disrupting life. You do not need depression to have the diagnosis, but depression can occur later. It is a medical illness, not a character flaw, and it is treatable.” [4]

Explain lithium. Lithium is one of the best-evidenced long-term treatments to prevent another mania or depression; trial evidence (BALANCE) supports lithium over valproate alone for relapse prevention in bipolar I when tolerated. We check kidney, thyroid, calcium, and sometimes ECG before and during treatment. Levels are timed 12 hours after the dose. Common effects include tremor, thirst, weight change; dangerous toxicity includes severe tremor, vomiting, confusion, unsteadiness — seek urgent help and hold doses. Avoid new NSAIDs and stay hydrated; tell other doctors you take lithium.[1][3]

Suicide. Bipolar illness raises suicide risk, especially in mixed or depressive periods. Lithium is associated with reduced suicidal behaviour in evidence reviews — still, any suicidal thoughts need same-day contact. Crisis plan and means safety. [2]

Future depression. We would not start an antidepressant alone; options include adjusting lithium or using other polarity-safe medicines. Sleep is a vital sign — protect regular sleep and watch early warning signs (needing less sleep with more energy). [4]

Close. Summarise, teach-back, written information, clinic/lab appointments, crisis contacts. [4]