Clinical risk management of the rapid-cycling bipolar patient

Important clinical-legal issues surround the management of patients with rapid-cycling bipolar disorder (RCBD). An increased risk of liability exposure may exist for improper diagnosis and treatment, lack of informed consent, inadequate assessment of the risk of violence toward self and others, and failure to monitor the patient. Practice guidelines may facilitate defensive practices by psychiatrists, which can increase the risk of liability. Clinical risk management combines professional expertise and knowledge of the patient with an understanding of the legal issues governing clinical practice to provide good care to patients and only secondarily to limit legal liability. A working understanding of the legal issues surrounding patient care in general and the RCBD patient in particular should provide more comfort and wider latitude in helping these difficult-to-treat patients.