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CMScript: Focus on Bipolar Disorder

Bipolar disorder affects approximately 45 million people worldwide and is the sixth leading cause of disability in the world. In South Africa, bipolar disorder affects up to 4% of the population. It often develops between the ages of 15 and 19 and rarely develops after 40. Men and women from all backgrounds are equally likely to develop the disorder. Men tend to have more manic episodes, while women experience more depressive episodes.


What is bipolar disorder?


Bipolar disorder is a serious mental illness that causes extreme mood swings, with periods of emotional highs (mania or hypomania) and lows (depression). During depressive episodes, individuals may experience profound sadness or hopelessness, along with a loss of interest or pleasure in most activities. Manic episodes, or the less severe hypomanic episodes, can lead to feelings of euphoria, excessive energy, creativity, grandiose or unusual irritability. These mood changes can affect sleep, energy, activity levels, judgment, behaviour, and the ability to think clearly. The severity of these episodes can make it challenging to perform everyday tasks, attend work or school, and maintain relationships.


What is covered as PMB level of care?


Bipolar disorder is covered as part of the prescribed minimum benefit (PMB) conditions under Diagnosis and Treatment Pair (DTP) code 902T. This DTP refers to “major affective disorders, including unipolar and bipolar depression”. The treatment component for this condition is specified in the regulations of the Medical Schemes Act (131 of 1998) as “hospital-based management up to 3 weeks per year (including inpatient electro-convulsive therapy and inpatient psychotherapy) or outpatient psychotherapy of up to 15 contacts per year”.


Bipolar disorder is also included on the Chronic Diseases List (CDL), and it has a specific medicine algorithm that is outlined in the regulations of the Medical Schemes Act (131 of 1998).


Detailed entitlements for bipolar disorder are available on the PMB Benefit Definition for Bipolar Disorder available here.




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