Name:

D B Double

Organisation:

Critical Psychiatry Network

General

There are no references in the document. This seems to be an increasing trend of NICE documents and does cause concern. The implication should not be that the document is merely stating incontrovertible "facts". It is important that the evidence for various statements can be assessed.

3(a)

Bipolar disorder is a diagnostic concept. It may be worth indicating the relatively recent nature of this concept and its relation to manic-depressive illness. The separation of bipolar I and II disorder is not a main feature in international classifications, and although generally accepted, its use in clinical practice varies and the overlap of bipolar II disorder with depressive disorder may need to be emphasised.

3(d)

It may be worth indicating the controversial nature of the evidence about aetiology. What does it mean to state that genetic and biological factors are probably important? What about developmental factors or are these subsumed under environmental factors?

4.3.1(b)

It may be worth commenting on the broadening of the concept of bipolar disorder over recent years.

4.3.1(d)

It may be worth commenting on the considerable prescribing which takes place outside licensed indications.