{"id":1208,"date":"2026-03-09T10:16:06","date_gmt":"2026-03-09T14:16:06","guid":{"rendered":"https:\/\/www.accessmhct.com\/youth\/?page_id=1208"},"modified":"2026-04-01T18:29:06","modified_gmt":"2026-04-01T22:29:06","slug":"bipolar-disorder","status":"publish","type":"page","link":"https:\/\/www.accessmhct.com\/youth\/resources-2\/provider-toolkit\/bipolar-disorder\/","title":{"rendered":"Bipolar Disorder"},"content":{"rendered":"\n<p>Bipolar disorder is one of the more serious psychiatric illnesses, with a lifetime prevalence of 2.4%. For up to half of the people with bipolar disorder, the illness begins at less than 13 years of age (very-early-onset bipolar disorder) or between 13 and 18 years of age (early-onset bipolar disorder). Early-onset versus late-onset bipolar disorder is associated with an elevated risk of suicidality, greater severity of depression and mania, a higher number of episodes, high level of comorbid anxiety and substance use, ultradian cycling, fewer days of euthymic mood, and an elevated risk of chronic illness course. In addition, the families of youth with bipolar disorder are under heavy strain, which can worsen the course of pediatric bipolar disorder.<\/p>\n\n\n\n<p>Diagnosing bipolar disorder in children and adolescents can be challenging, as the presentation of symptoms may differ from those in adults. In addition, mood swings are a normal part of childhood and adolescence, making it difficult to carefully evaluate symptoms over time. Furthermore, pediatric bipolar disorder often coexists with neurodevelopmental comorbidities such as attention deficit hyperactive disorder, oppositional defiant disorder, conduct disorder, anxiety disorders, learning disabilities and less frequently, autistic spectrum disorder. It has been debated whether pediatric bipolar disorder and classic adult form of bipolar disorder represent the same illness. Evidence from neurological findings, overlap in comorbidities and longitudinal studies suggest a continuity between the juvenile and adult formal bipolar disorder.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading has-text-align-left\">Bipolar Disorder Resources<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Guidelines for Diagnosis and Screening<\/h3>\n\n\n\n<div class=\"wp-block-esab-accordion accordion-fa8dac5a\" data-mode=\"global\"><div class=\"esab__container\">\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">Guidelines for Diagnosis<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<p><span style=\"text-decoration: underline;\">DSM V TR Criteria<\/span><\/p>\n\n\n\n<p>Suggested screening question: Have there been times, lasting at least a few days, when you felt the opposite of depressed, when you were very cheerful or happy and this felt different from your normal self?<\/p>\n\n\n\n<p><strong>If yes, ask:<\/strong> During those times did you feel this way all day or most of the day? For how many days did this last and\/or result in you being hospitalized? Did this ever cause you significant trouble with your friends or family, at school or work or in another setting?<\/p>\n\n\n\n<p>There are three main types of bipolar disorder:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Bipolar I disorder: Requires at least one manic episode.<\/li>\n\n\n\n<li>Bipolar II disorder: Requires at least one depressive episode and at least one hypomanic (milder form of mania) episode.<\/li>\n\n\n\n<li>Cyclothymic disorder: Bipolar-like symptoms for at least two years but your symptoms do not quite meet the criteria for bipolar disorder I or II.<\/li>\n<\/ol>\n\n\n\n<p><strong><u>Bipolar I Disorder<\/u><\/strong><\/p>\n\n\n\n<p>The DSM-5 TR criteria for bipolar disorder include:<\/p>\n\n\n\n<p>Bipolar I Disorder: It requires at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes.<\/p>\n\n\n\n<p>Manic Episode: It is characterized by an elevated, expansive, or irritable mood lasting at least one week, along with additional symptoms such as increased energy, decreased need for sleep, and grandiosity.<\/p>\n\n\n\n<p>Hypomanic Episode: It is similar to a manic episode but less severe and lasts at least four consecutive days.<\/p>\n\n\n\n<p>Major Depressive Episode: It involves a depressed mood or loss of interest or pleasure in most activities, lasting at least two weeks.<\/p>\n\n\n\n<p><strong>NOTE:<\/strong> These episodes must not be better explained by other mental disorders.<\/p>\n\n\n\n<p class=\"has-text-align-center\"><strong><u>Manic Episode<\/u><\/strong><\/p>\n\n\n\n<p>A. Inclusion: Requires at least three of the following criteria during a manic episode, lasting for a week or more.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>inflated self-esteem or grandiosity:\n<ul class=\"wp-block-list\">\n<li>During that period, did you feel especially confident, as though you could accomplish something extraordinary that you could not have done otherwise?<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>decreased need for sleep:\n<ul class=\"wp-block-list\">\n<li>During that period, did you notice any change in how much sleep you needed to feel rested?&nbsp;<\/li>\n\n\n\n<li>Did you feel rested after less than three hours of sleep?<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>more talkative than usual:\n<ul class=\"wp-block-list\">\n<li>During that period, did anyone tell you that you talk more than usual?<\/li>\n\n\n\n<li>Was it hard to interrupt you?&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>flight of ideas:\n<ul class=\"wp-block-list\">\n<li>During that, were your thoughts racing?&nbsp;<\/li>\n\n\n\n<li>Did you have so many ideas that you could not keep up with them?&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>distractibility:\n<ul class=\"wp-block-list\">\n<li>During that period were you having more trouble than usual focusing?<\/li>\n\n\n\n<li>Did you find yourself distracted easily?<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>increased goal-directed activity:\n<ul class=\"wp-block-list\">\n<li>During that period, how did you spend your time?&nbsp;<\/li>\n\n\n\n<li>Did you find yourself much more active than usual?<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>excessive involvements in activities that have a high potential for pain consequences:\n<ul class=\"wp-block-list\">\n<li>During that period, did you engage in activities that were unusual for you?&nbsp;<\/li>\n\n\n\n<li>Did you spend money, use substances, engage in sexual activities and are aware that is unusual for you?&nbsp;<\/li>\n\n\n\n<li>Did any of these activities cause trouble for anyone?<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<p>B. Exclusion: The occurrence of manic and major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.<\/p>\n\n\n\n<p>C. Exclusion: The episode is not due to the physiological effect of substances or other medical conditions.&nbsp; However, a manic episode that emerges during antidepressant treatment but persists beyond the physiological effect of treatment meets criteria for the diagnosis.<\/p>\n\n\n\n<p>D. Modifiers<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Current (or most recent) episode\n<ul class=\"wp-block-list\">\n<li>manic<\/li>\n\n\n\n<li>hypomanic<\/li>\n\n\n\n<li>depressed<\/li>\n\n\n\n<li>unspecified\n<ul class=\"wp-block-list\">\n<li>use when symptoms but not the duration of the criteria are met<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Specifiers\n<ul class=\"wp-block-list\">\n<li>with anxious distress<\/li>\n\n\n\n<li>with mixed features:\n<ul class=\"wp-block-list\">\n<li>use if at least 3 of the symptoms of major depressive episode are present simultaneously&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>with rapid cycling&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n\n\n\n<li>with melancholic features<\/li>\n\n\n\n<li>with atypical features&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n\n\n\n<li>with mood-congruent psychotic features&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n\n\n\n<li>with mood-incongruent psychotic features&nbsp;&nbsp;<\/li>\n\n\n\n<li>with catatonia&nbsp;&nbsp;&nbsp;<\/li>\n\n\n\n<li>with peripartum onset lined with seasonal pattern<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Course and Severity\n<ul class=\"wp-block-list\">\n<li>current or most recent episode manic, hypomanic, depressed, unspecified<\/li>\n\n\n\n<li>mild, moderate, severe<\/li>\n\n\n\n<li>with psychotic features<\/li>\n\n\n\n<li>in partial remission, in full remission&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n\n\n\n<li>unspecified<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Alternatives\n<ul class=\"wp-block-list\">\n<li>If substance use directly causes the episode, including a medication prescribed to treat depression, consider substance\/medication-induced bipolar and related disorder.<\/li>\n\n\n\n<li>If another medical condition causes the episode, consider bipolar disorder and related disorder due to another medical condition.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<p><strong>NOTE: <\/strong>Acute mania is a medical emergency and should be referred for urgent psychiatric assessment.<\/p>\n\n\n\n<p class=\"has-text-align-center\"><strong><u>Bipolar II Disorder<\/u><\/strong><\/p>\n\n\n\n<p><strong>DSM 5-TR Criteria<\/strong><\/p>\n\n\n\n<ol style=\"list-style-type:upper-alpha\" class=\"wp-block-list\">\n<li>Inclusion:<strong> <\/strong>It requires at least three of the following criteria during a hypomanic episode lasting at least 4 days.<\/li>\n<\/ol>\n\n\n\n<ol class=\"wp-block-list\">\n<li>inflated self-esteem or grandiosity:\n<ul class=\"wp-block-list\">\n<li>During that period, did you feel especially confident, as though you could accomplish something extraordinary that you could not have done otherwise?<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>decreased needs for sleep:\n<ul class=\"wp-block-list\">\n<li>During that period, did you notice any change in how much sleep you needed to feel rested?&nbsp;<\/li>\n\n\n\n<li>Did you feel rested after less than three hours of sleep?<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>more talkative than usual:\n<ul class=\"wp-block-list\">\n<li>During that period, did anyone tell you that you talk more than usual?<\/li>\n\n\n\n<li>Was it hard to interrupt you?&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>flight of ideas:\n<ul class=\"wp-block-list\">\n<li>During that, were your thoughts racing?<\/li>\n\n\n\n<li>Did you have so many ideas calling that you could not keep up with them?&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>distractibility:\n<ul class=\"wp-block-list\">\n<li>During that period were you having more trouble than usual focusing?&nbsp;<\/li>\n\n\n\n<li>Did you find yourself distracted easily?<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>increased goal-directed activity:\n<ul class=\"wp-block-list\">\n<li>During that period, how did you spend your time?&nbsp;<\/li>\n\n\n\n<li>Did you find yourself much more active than usual?<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>excessive involvements in activities that have a high potential for pain consequences:\n<ul class=\"wp-block-list\">\n<li>During that period, did you engage in activities that were unusual for you?<\/li>\n\n\n\n<li>Did you spend money, use substances, engage in sexual activities and are aware that is unusual for you?&nbsp;<\/li>\n\n\n\n<li>Did any of these activities cause trouble for anyone?<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<ol start=\"2\" style=\"list-style-type:upper-alpha\" class=\"wp-block-list\">\n<li>Exclusion: If there has ever been a manic episode or if episode is attributable to physiological effects of a substance\/medication, the diagnosis not given.<\/li>\n\n\n\n<li>Exclusion: If the hypomanic episode is better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder, the diagnosis is not given.<\/li>\n\n\n\n<li>Modifiers:<\/li>\n<\/ol>\n\n\n\n<ol class=\"wp-block-list\">\n<li>specify current (or most recent) episode&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<ul class=\"wp-block-list\">\n<li>hypomanic&nbsp;&nbsp;<\/li>\n\n\n\n<li>depressed&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>specifiers\n<ul class=\"wp-block-list\">\n<li>anxious distress<\/li>\n\n\n\n<li>mixed emotions<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>use if at least three of the symptoms of major depressive episode are present simultaneously\n<ul class=\"wp-block-list\">\n<li>rapid cycling<\/li>\n\n\n\n<li>mood-congruent psychotic features<\/li>\n\n\n\n<li>catatonia<\/li>\n\n\n\n<li>peripartum onset<\/li>\n\n\n\n<li>unspecified<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>course and severity\n<ul class=\"wp-block-list\">\n<li>current or most recent episode:\n<ul class=\"wp-block-list\">\n<li>manic<\/li>\n\n\n\n<li>hypomanic<\/li>\n\n\n\n<li>depressed<\/li>\n\n\n\n<li>unspecified<br><strong>+<\/strong><\/li>\n\n\n\n<li>mild<\/li>\n\n\n\n<li>moderate<\/li>\n\n\n\n<li>severe<\/li>\n\n\n\n<li>in partial remission<\/li>\n\n\n\n<li>in full remission<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Alternatives:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<ul class=\"wp-block-list\">\n<li>If a person reports symptoms for two or more years with multiple hypomanic or depressive symptoms but have never risen to a level of hypomanic or major depressive episode, consider cyclothymic disorder.&nbsp; During the same two-year period (one year in children and adolescents), hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than two months at the time.<\/li>\n\n\n\n<li>&nbsp;If the symptoms are due to physiological effects of a substance or another medical condition, the diagnosis is not given.<\/li>\n\n\n\n<li>If a person experiences symptoms characteristic of bipolar disorder that caused clinically significant distress of functional impairment without meeting full criteria of bipolar disorder, consider unspecified bipolar and related disorder.&nbsp; If you wish to communicate the specific reason for the person symptoms do not meet the criteria, consider other specified bipolar disorder and related disorders.&nbsp; Examples include short acting cyclothymia and hypomanic episode without prior major depressive episode.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<p class=\"has-text-align-center\"><strong><u>Depressive Episode:<\/u><\/strong><\/p>\n\n\n\n<p>Inclusions: Requires the presence of at least five of the following symptoms, which must include either depressed mood or loss of interest or pleasure (anhedonia), during the same two-week episode. <\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>depressed mood most of the day&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n\n\n\n<li>markedly diminished interest in the activities of pleasures&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n\n\n\n<li>significant weight loss or gain:\n<ul class=\"wp-block-list\">\n<li>During that period, did you notice any changes in your appetite?<\/li>\n\n\n\n<li>Did you notice any change in your weight?&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>insomnia or hypersomnia:\n<ul class=\"wp-block-list\">\n<li>During that period, how much and how well were you sleeping?&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>psychomotor agitation or retardation:\n<ul class=\"wp-block-list\">\n<li>During that period, did anyone tell you that you seemed to move faster or slower than usual?&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>fatigue or loss of energy:\n<ul class=\"wp-block-list\">\n<li>During that period, what was your energy level like?<\/li>\n\n\n\n<li>Did anyone tell you that you seemed worn down as less energetic than usual?&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>feeling worthlessness or excessive guilt:\n<ul class=\"wp-block-list\">\n<li>During that period, did you feel tremendous regret or guilt about current or past events or relationships?&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>diminished concentration:\n<ul class=\"wp-block-list\">\n<li>During that period, were you unable to make decisions or concentrate like you usually do?&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>recurrent thoughts of death or suicide:\n<ul class=\"wp-block-list\">\n<li>During that period, did you think about death more than you usually do?<\/li>\n\n\n\n<li>Have you thought about hurting yourself or taking your own life.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<p>Patients may present with a history of manic, hypomanic, depressive, or mixed symptoms.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">Guidelines for Screening and Assessment<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<p><span style=\"text-decoration: underline;\">Clinical Presentation:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients usually present with a history of mood lability, episodic nature, aggression, elevated mood, decreased need of sleep, increased goal-directed activity, rapid sleep, flight of ideas, increased irritability, difficulty focusing and concentrating, risk-taking behaviors, alternating with depressive symptoms of social withdrawal anhedonia, hopelessness and worthlessness.<\/li>\n\n\n\n<li>Primary care providers should take detailed chronological history of symptomatology and behaviors, from the start of symptoms.<\/li>\n\n\n\n<li>Family history, with close relatives having history of bipolar disorder raises possibility of patients presenting with significant mood lability, mood swings, aggression and irritability has bipolar disorder.<\/li>\n\n\n\n<li>Sometimes an initial presentation may be a single episode of major depressive disorder evolving into significant mood lability with or without manic symptoms.&nbsp; Sometimes patients may present with consistent ongoing irritability and aggression without history of mania, hypomania or depressive symptoms.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-text-align-center\"><strong><u>Differential Diagnosis of Bipolar Disorder<\/u><\/strong><\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">ADHD:<\/span><\/p>\n\n\n\n<p>Patients with ADHD present with symptoms of hyperactivity, impulsiveness and inattentiveness.&nbsp; Patients have difficulty sitting still, have a history of excessive restless energy, being continuously fidgety, moving from activities to activities and requiring repeated redirections.&nbsp; Patients have a history of poor concentration, short attention span and inability to focus and complete tasks.&nbsp; Patients are disorganized and forgetful.&nbsp; ADHD symptoms are present all day long, every day while symptoms of bipolar disorder mood lability are episodic in nature.<\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">Oppositional Defiant Disorder:<\/span><\/p>\n\n\n\n<p>Patient is defiant, refuses to follow directions, challenges authority figures.&nbsp; Patient does as he pleases.&nbsp; Patients with oppositional defiant disorder are reactionary when they do not get their way resulting in meltdowns, aggressive episodes lasting from few minutes to few hours.<\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">Conduct Disorder:<\/span><\/p>\n\n\n\n<p>Patient presents with a repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate societal norms or rules are violated.&nbsp; Patients bully, threaten or intimidate others. Patients often initiate physical fights and have used a weapon that can cause serious physical harm to others.&nbsp; Patients have a history of being physically cruel to people or animals. The patient has stolen.&nbsp; Patients might have a history of forcing someone into sexual activity or have deliberately engaged in fire-setting with an intention of causing serious damage.&nbsp; Patients have a history of deliberately destroying others&#8217; property or have a history of breaking into someone else&#8217;s house building or car.&nbsp; Patients may have a history of running away from home overnight without permission or lying for personal gain.<\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">Disruptive Mood Dysregulation Disorder:<\/span><\/p>\n\n\n\n<p>Patient has a history of severe recurrent temper outbursts in response to common stressors, averaging at least three times per week, for at least one year.&nbsp; Outburst must occur in at least two distinct settings such as school or home, be severe in at least one setting, and begin before 10 years of age.&nbsp; Temper tantrums and behavioral outbursts are disproportionate reactions to the stimuli.&nbsp; Patients with disruptive mood disorder aggression disorder will not have hypomanic or manic symptoms.<\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">Anxiety Disorders:<\/span><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Generalized Anxiety Disorder<\/li>\n\n\n\n<li>Panic Disorder<\/li>\n<\/ol>\n\n\n\n<p>Intensifying of anxiety disorder may present in pediatric age group as escalating behavior difficulties, mood lability and aggressive behaviors.<\/p>\n\n\n\n<p>Mood lability and aggressive behaviors are noticed in pediatric age groups with anxiety disorders when patients are unable to manage the anxiety symptoms and feel out of control.<\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">PTSD:<\/span><\/p>\n\n\n\n<p>Patient has an exposure to actual or threatened death, serious injury or sexual violation. The exposure can be firsthand or witnessed.&nbsp; Patients must experience at least one of the following intrusive symptoms for at least one month after the traumatic experience.&nbsp; Memories, flashbacks, nightmares, exposure distress and physiological reactions related to trauma.<\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">Reactive Attachment Disorder, Disinhibited Type:<\/span><\/p>\n\n\n\n<p>Patients have childhood experience of extremes of insufficient care, before age five years, that resulted in rare or minimal comfort seeking and rare minimal response to comfort.&nbsp; Patients have a lack of social and emotional responsiveness to others.&nbsp; They will have limited positive effects with episodes of unexplained irritability, sadness of fearfulness, which are evident during non-threatening interactions with caregivers.&nbsp; Patients may exhibit profoundly disturbed externalizing behaviors including violent behavior outburst.<\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">Substance Use Disorder:<\/span><\/p>\n\n\n\n<p>Mood lability and aggressive behaviors are as a result of substance abuse.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">Bipolar Disorder Screening and Rating Scales<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/psychology-tools.com\/test\/young-mania-rating-scale\">Young Mania Rating Scale<\/a><\/li>\n\n\n\n<li><a href=\"file:\/\/\/C:\/Users\/bmiller1\/OneDrive%20-%20Elevance%20Health\/Documents\/CMRS-P_PBD%20Screener.pdf\">Pediatric Mania Rating Scale<\/a><\/li>\n\n\n\n<li><a href=\"file:\/\/\/C:\/Users\/bmiller1\/OneDrive%20-%20Elevance%20Health\/Documents\/K-SADS%20Mania%20Rating%20Scales.pdf\">K-SADS Mania Rating Scale<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.sadag.org\/images\/pdf\/mdq.pdf\">Mood Disorder Questionnaire<\/a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n\n\n\n<li><a href=\"file:\/\/\/C:\/Users\/bmiller1\/OneDrive%20-%20Elevance%20Health\/Documents\/altman-mania-scale.pdf\">Altman Mania Rating Scale<\/a><\/li>\n\n\n\n<li><a href=\"file:\/\/\/C:\/Users\/bmiller1\/OneDrive%20-%20Elevance%20Health\/Documents\/3_cidi-based%20bipolar-do-screening.pdf\">CIDI-based bipolar disorder Screen<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<div style=\"height:17px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Guidelines for Treatment<\/h3>\n\n\n\n<p>Call Your ACCESS Mental Health for Youth Hub Team for assistance:<\/p>\n\n\n\n<p>Hartford Hospital Hub: 1-855-561-7135<br>Wheeler Clinic Hub: 1-855-631-9835<br>Yale Child Study Center Hub: 1-844-751-8955<\/p>\n\n\n\n<div class=\"wp-block-esab-accordion accordion-82228b3e\" data-mode=\"global\"><div class=\"esab__container\">\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">Medication Guidelines<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<p>Second Generation Antipsychotic Mood Stabilizers:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>risperidone<strong> <\/strong>(Risperdal):&nbsp;&nbsp;&nbsp;<ul><li>FDA has approved Risperidone for schizophrenia for those above age 13 and bipolar disorder for age over 10 years. It is also an indication for aggressive behaviors in autistic spectrum disorder.<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Initiate dose of Risperidone at a dose of 0.25 mg once daily for children and 0.5 mg once daily in adolescents to a maximum dose of 3 mg\/day in children and 6 mg\/day in adolescents<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>aripiprazole<strong> <\/strong>(Abilify):\n<ul class=\"wp-block-list\">\n<li>Initiate dose of Abilify at a dose of 2.5 mg once daily for children and 5 mg once daily for adolescent.&nbsp; Maximum dose allowed for children is 15 mg\/day and for adolescents it is 30 mg\/day.&nbsp; FDA has approved Abilify for schizophrenia for youth over 13 years of age and bipolar for age over 10 years. It is also approved for aggressive behavior and autistic spectrum disorder for age over six years of age.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>quetiapine (Seroquel):<ul><li>&nbsp;FDA approved quetiapine for schizophrenia, over age 13 years of age and bipolar for age over 10 years.<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Initiate Seroquel dose at a dose of 12.5 mg once daily for children and 25 mg once daily for adolescents.&nbsp; The maximum allowed dose for children is 300 mg\/day and adolescent are 600 mg\/day.&nbsp;<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>olanzapine<strong> <\/strong>(Zyprexa):<ul><li>FDA approved olanzapine for schizophrenia over 13 years of age and for bipolar disorder for over 13 years of age.<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Initiate dose of Zyprexa at a dose of 2.5 mg once daily for children and 2.5 mg to 5 mg\/day for adolescents.&nbsp; Maximum allowed dose for children is 15 mg\/day and for adolescents it is 30 mg\/day.&nbsp;<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>lurasidone<strong> <\/strong>(Latuda):<ul><li>FDA has approved Latuda for bipolar disorder for ages between 10 and 17.<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Initiate therapy at 20 mg once daily in the morning.&nbsp; Dosage may be titrated in 20 mg increments every week to a maximum dose of 80 mg\/day.&nbsp; Studies have shown that 67% of patients receive doses between 20 to 40 mg\/day.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>paliperidone<strong> <\/strong>(Invega):<\/li>\n\n\n\n<li>The FDA has approved schizophrenia for over 12 years.<\/li>\n\n\n\n<li>For schizoaffective disorders, paliperidone safety and efficacy is not yet established for age below 18 years.\n<ul class=\"wp-block-list\">\n<li>Therapy can be initiated at a dose of 1.5 mg to 3 mg\/day.&nbsp; Dosing can be increased every week by an increment of 1.5 to 3 mg\/day, not to exceed a total dose of 6 mg\/day.&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>cariprazine (Vraylar): FDA safety and efficacy for patients under 18 years old is not yet established.\n<ul class=\"wp-block-list\">\n<li>Initiate therapy at a dose of 1.5 mg once daily.&nbsp; Titrate medication every three to five days and increment of 1.5 to 3 mg\/day not to exceed a dose of 6 mg\/day.&nbsp;<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>brexpiprazole (Rexulti): FDA has approved brexpiprazole for schizophrenia in patients aged 13 and above.\n<ul class=\"wp-block-list\">\n<li>Initiate therapy at a dose of 0.5 mg once daily. Titrate in an increment of 0.5 to 1 mg\/day weekly not to exceed a total dose of 4 mg\/day.&nbsp;<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>Antiepileptics:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>valproic acid (Depakote):<\/li>\n<\/ul>\n\n\n\n<p>Initiate valproic acid at a dose of 250 mg\/day in two divided doses.&nbsp; Titrate dose to a maximum range of 500 to 2000 mg\/day. Monitor five therapeutic blood levels days to one week after. titration of doses to a therapeutic level between 50 and 100 mcg\/mL. FDA approved for epilepsy for youth 10 years of age and older.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>carbamazepine (Tegretol):<\/li>\n<\/ul>\n\n\n\n<p>For children under age six years initiate therapy in 10 to 20 mg\/kg\/day in two-three divided doses not to exceed a dose of 35 mg\/kg\/day in 2-3 divided doses.&nbsp; For ages between 6-12 initiate therapy at 100 mg twice daily to be increased by 100 mg\/day on a weekly basis for maintenance dose of 400 to 800 mg\/day in two-three divided doses and not to exceed 1000 mg\/day.&nbsp; Over 12 years of age initiate therapy in 200 mg twice daily and increase by 200 mg\/day every week not to exceed 1000 mg\/day for ages between 12 and 15 and over 1200 mg for ages over 15 years. Carbamazepine is FDA approved for children over six years of age for partial complex seizures please.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>lamotrigine (Lamictal):<\/li>\n<\/ul>\n\n\n\n<p>Initiate therapy at 25 mg once daily and titrated in a 25 mg increments every one to two weeks to a maximum dose of 200 to 300 mg\/day and once or twice divided dosing. Safety and effectiveness are not established, and it is not approved by FDA for use in minors for bipolar disease.&nbsp; Compliance with lamotrigine is important.&nbsp; If dosing is missed for more than five days, then patient needs to be restarted from beginning.&nbsp; Patient needs to be educated regarding side effects of photosensitivity and Stevens-Johnson syndrome.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Lithium: The adverse effects-risks of toxicity and monitor blood levels.<\/li>\n<\/ul>\n\n\n\n<p>Dosing can be started at a dose of 15 to 20 mg\/kg\/day in two divided doses while in adults and it can be started at the dose of 300 mg\/day in two divided doses.&nbsp; Titration of the dose needs to happen every five to seven days to achieve a therapeutic level of 0.6-1.2 mEq\/L. FDA has approved lithium for bipolar disorder for children over age 12 years.<\/p>\n\n\n\n<p>Antidepressants:<\/p>\n\n\n\n<p>Patients with bipolar disorder may present with the most recent episode of bipolar I disorder or bipolar II disorder be a depressive episode or a mixed (mania, hypomania, or depressive symptoms) episode. In such a situation, antidepressants may form part of the regimen with mood stabilizers or a combination therapy of mood stabilizers.&nbsp; In such a situation, it is recommended that primary care providers seek consultation from ACCESS Mental Health for Youth or other psychiatric providers.<strong><\/strong><\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">SSRI (Selective Serotonin Reuptake Inhibitors)<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>fluoxetine (Prozac)<\/li>\n\n\n\n<li>sertraline (Zoloft)<\/li>\n\n\n\n<li>citalopram (Celexa)<\/li>\n\n\n\n<li>escitalopram (Lexapro)<\/li>\n<\/ul>\n\n\n\n<p><span style=\"text-decoration: underline;\">SNRI (Serotonin Norepinephrine Reuptake Inhibitors)<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>duloxetine (Cymbalta)<\/li>\n\n\n\n<li>venlafaxine (Effexor)<\/li>\n\n\n\n<li>desvenlafaxine (Pristiq)<\/li>\n<\/ul>\n\n\n\n<p>For dosing of antidepressants, please refer to the Depression toolkit on ACCESS Mental Health for Youth website. (insert hyperlink)<\/p>\n\n\n\n<p><strong>NOTE: <\/strong>It is strongly recommended that primary care providers seek consultation from ACCESS Mental Health for Youth or other child psychiatrists for any questions or concerns regarding assessment, treatment and medication management of patients presenting with bipolar disorder.<strong><\/strong><\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">Medication trial 1:<\/span> Monotherapy with FDA approved second-generation antipsychotics like risperidone, aripiprazole, quetiapine or olanzapine.<\/p>\n\n\n\n<p><a>\u2193<\/a><\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\">Medication trial 2:<\/span> If trial with monotherapy second-generation antipsychotic does not alleviate symptoms after titrating for two to four weeks switch to another second-generation antipsychotic. Do not combine second-generation antipsychotics.<\/p>\n\n\n\n<p>\u2193<\/p>\n\n\n\n<p>If the above 2 medication trials do not work, then the patient may need a combination of medications. Patients may benefit from a combination of second-generation antipsychotic with lithium or a second-generation antipsychotic with antiepileptic mood stabilizers. This combination regimen with the guidance of ACCESS Mental Health for Youth child psychiatrist.<\/p>\n\n\n\n<p>\u2193<\/p>\n\n\n\n<p>If a patient presents with a mixed episode, then the patient may need a combination of a mood stabilizer with an antidepressant. Mood stabilizers can be combined with antidepressants like SSRIs or SNRIs.<\/p>\n\n\n\n<p>It is imperative for primary care providers to understand that frequently bipolar disorder patients will also have significant depressive symptoms.&nbsp; It is important that a mood stabilizer may be used prior to or along with an antidepressant to address symptoms of depression or bipolar depression.<\/p>\n\n\n\n<p><strong>REMEMBER: <\/strong>ACCESS Mental Health for Youth can also help primary care providers connect their patients and families with child psychiatric and behavioral treatment services.<\/p>\n\n\n\n<p><strong>Practice Parameters:<\/strong><\/p>\n\n\n\n<p><a href=\"http:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/practice_parameters\/JAACAP_Bipolar_2007.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">AACAP Practice Parameter for the Assessment and Treatment of Children with Bipolar Disorder Vol 6 January 2007<\/a><\/p>\n\n\n\n<p><a href=\"http:\/\/www.nimh.nih.gov\/health\/publications\/bipolar-disorder-in-children-and-adolescents\/index.shtml\" target=\"_blank\" rel=\"noreferrer noopener\">National Institute of Mental Health (NIMH) &#8211; Bipolar Disorder in Children and Adolescence<\/a><\/p>\n\n\n\n<p><strong>Laboratory Work-up for Medication Management:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>complete blood count with differential<\/li>\n\n\n\n<li>comprehensive metabolic panel<\/li>\n\n\n\n<li>lipid panel<\/li>\n\n\n\n<li>thyroid panel<\/li>\n\n\n\n<li>Hb A1c<\/li>\n\n\n\n<li>prolactin Level<\/li>\n<\/ul>\n\n\n\n<p><strong>Significant Adverse Effects of Recommended Medications:<\/strong><\/p>\n\n\n\n<p>For second generation antipsychotic prescribers need to be mindful of weight gain, increasing BMI, metabolic syndrome, neuroleptic malignant syndrome, extrapyramidal side effects, prolactin level elevation, tardive dyskinesia.&nbsp; Prescribing antipsychotic requires completing AIMS every six months to a year.<\/p>\n\n\n\n<p>For valproic acid prescribers need to be mindful of hepatotoxicity, PCOS with female patients, teratogenicity and auto induction of hepatic enzymes leading to a need higher dose of valproic acid needed to maintain therapeutic levels.<\/p>\n\n\n\n<p>A lithium prescriber needs to be mindful of lithium toxicity due to increased blood levels of lithium due to compromised renal function, cardiovascular function and dehydration, hypothyroidism, and teratogenicity.&nbsp; Lithium is not metabolized and is excreted through kidneys.&nbsp; Therefore, to avoid toxicity NSAIDs should be avoided.&nbsp; It is also recommended to avoid diuretics, which will increase lithium levels and hence chances of lithium toxicity.&nbsp; It is important that patients taking lithium should hydrate appropriately.<\/p>\n\n\n\n<p>For antidepressants, parents need education regarding black box warning.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">Non-pharmacological Treatment<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<p><strong>Therapy:<\/strong><\/p>\n\n\n\n<p>Patient and family need to be involved in therapy both individual and family system being involved to address psychosocial issues, along with interpersonal difficulties and improve patient&#8217;s self-esteem with social and coping skills.&nbsp; Family therapy to work on resetting familial hierarchy, empowering parents, and working on parenting skills. Positive parenting programs can be helpful.<\/p>\n\n\n\n<p>Psychoeducation of parents regarding parents is of utmost importance for patient management.<\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<h3 class=\"wp-block-heading toppad\">Additional Provider and Family Resources<\/h3>\n\n\n\n<div class=\"wp-block-esab-accordion accordion-9734a792\" data-mode=\"global\"><div class=\"esab__container\">\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">ACCESS Mental Health for Youth Clinical Conversations Trainings<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<ul class=\"wp-block-list\">\n<li>May 4, 2023: \u201cBipolar Disorder Diagnosis and Treatment in Pediatrics\u201d\n<ul class=\"wp-block-list\">\n<li><em><a href=\"https:\/\/vimeo.com\/823829946\/e13f19fdbc\" target=\"_blank\" rel=\"noreferrer noopener\">view recording<\/a><\/em><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>May 6, 2021: &#8220;Mood Dysregulation and Behavioral Outbursts&#8221;\n<ul class=\"wp-block-list\">\n<li><em><a href=\"https:\/\/vimeo.com\/546140790\/a00d1c546a\" target=\"_blank\" rel=\"noreferrer noopener\">view recording<\/a><\/em><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>June 3, 2021: &#8220;Medication Management for Mood Dysregulation&#8221;\n<ul class=\"wp-block-list\">\n<li><em><a href=\"https:\/\/vimeo.com\/558661121\/92aff4071c\" target=\"_blank\" rel=\"noreferrer noopener\">view recording<\/a><\/em><\/li>\n\n\n\n<li><a href=\"https:\/\/link.zixcentral.com\/u\/d3eca302\/wgeh2ZrE6xGTFWIrh3soMg?u=https%3A%2F%2Fwww.nimh.nih.gov%2Fresearch%2Fresearch-conducted-at-nimh%2Fresearch-areas%2Fclinics-and-labs%2Fedb%2Fmbdu%2Faffective-reactivity-index-ari\"><em>Affective Reactivity Index from NIMH<\/em><\/a><\/li>\n\n\n\n<li><em><a href=\"https:\/\/www.accessmhct.com\/wp-content\/uploads\/sites\/4\/2021\/08\/Medications-for-Mood-Dyregulation-June-3-2021-ppt.pdf\">Medications for Mood Dysregulation June 3, 2021 ppt<\/a>&nbsp;-powerpoint<\/em><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">Family Resources<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<p><strong>Books:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u201cThe Bipolar Disorder Survival Guide: What You and Your Family Need to Know, by Miklowitz DJ (2002)<\/li>\n\n\n\n<li>\u201cThe Bipolar Child\u201d by Demitri Papolos, MD and Janice Papolos<\/li>\n<\/ul>\n\n\n\n<p><strong>Websites:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients and families can benefit from information and connection with support groups on the following websites:<\/li>\n\n\n\n<li>Websites National Association for the Mentally Ill:&nbsp;&nbsp;<a href=\"http:\/\/www.nami.org\">www.nami.org<\/a><\/li>\n\n\n\n<li>The Depression and Bipolar Support Alliance (DBSA):&nbsp;&nbsp;<a href=\"http:\/\/www.dbsalliance.org\">www.dbsalliance.org<\/a><\/li>\n\n\n\n<li>The Balanced Mind Parent Network (a program of DBSA): <a href=\"http:\/\/www.thebalancedmind.org\/\">http:\/\/www.thebalancedmind.org\/<\/a><\/li>\n\n\n\n<li>AACAP Bipolar Disorder Resource Center <a href=\"https:\/\/www.aacap.org\/AACAP\/Families_and_Youth\/Resource_Centers\/Bipolar_Disorder_Resource_Center\/Home.aspx\">https:\/\/www.aacap.org\/AACAP\/Families_and_Youth\/Resource_Centers\/Bipolar_Disorder_Resource_Center\/Home.aspx<\/a><\/li>\n\n\n\n<li>AACAP &#8211; BIPOLAR DISORDER: PARENTS\u2019 MEDICATION GUIDE\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/resource_centers\/resources\/med_guides\/BipolarDisorderGuide_Web.pdf\">https:\/\/www.aacap.org\/App_Themes\/AACAP\/docs\/resource_centers\/resources\/med_guides\/BipolarDisorderGuide_Web.pdf<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>AACAP Facts for Families: Bipolar Disorder:\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.aacap.org\/AACAP\/Families_and_Youth\/Facts_for_Families\/FFF-Guide\/Bipolar-Disorder-In-Children-And-Teens-038.aspx\">https:\/\/www.aacap.org\/AACAP\/Families_and_Youth\/Facts_for_Families\/FFF-Guide\/Bipolar-Disorder-In-Children-And-Teens-038.aspx<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>PsychGuides.com: <a href=\"http:\/\/www.psychguides.com\/guides\/living\u2010with\u2010bipolar\u2010disorder\/\">http:\/\/www.psychguides.com\/guides\/living\u2010with\u2010bipolar\u2010disorder\/<\/a><\/li>\n\n\n\n<li>National Institute of Mental Health (NIH): <a href=\"http:\/\/www.nimh.nih.gov\/health\/publications\/bipolar\u2010 disorder\u2010in\u2010children\u2010and\u2010teens\u2010easy\u2010to\u2010read\/index.shtml\">http:\/\/www.nimh.nih.gov\/health\/publications\/bipolar\u2010 disorder\u2010in\u2010children\u2010and\u2010teens\u2010easy\u2010to\u2010read\/index.shtml<\/a><\/li>\n\n\n\n<li>Parent Version of the Young Mania Rating Scale (P\u2010YMRS) <a href=\"http:\/\/www.thebalancedmind.org\/learn\/library\/parent\u2010version\u2010of\u2010the\u2010young\u2010mania\u2010rating\u2010 scale\u2010p\u2010ymrs\">http:\/\/www.thebalancedmind.org\/learn\/library\/parent\u2010version\u2010of\u2010the\u2010young\u2010mania\u2010rating\u2010 scale\u2010p\u2010ymrs<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">Provider Resources<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<ul class=\"wp-block-list\">\n<li>AACAP Bipolar Disorder Resource Center <a href=\"https:\/\/www.aacap.org\/AACAP\/Families_and_Youth\/Resource_Centers\/Bipolar_Disord%20er_Resource_Center\/Home.aspx\">https:\/\/www.aacap.org\/AACAP\/Families_and_Youth\/Resource_Centers\/Bipolar_Disord er_Resource_Center\/Home.aspx<\/a><\/li>\n\n\n\n<li>NAMI National Alliance on Mental Illness\n<ul class=\"wp-block-list\">\n<li>&nbsp;<a href=\"https:\/\/www.nami.org\/learn\u2010more\/mental\u2010health\u2010conditions\/bipolar\u2010disorder\">https:\/\/www.nami.org\/learn\u2010more\/mental\u2010health\u2010conditions\/bipolar\u2010disorder<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Medscape Bipolar Learning Center (Get CME from bipolar learning modules)\n<ul class=\"wp-block-list\">\n<li><a href=\"http:\/\/www.medscape.org\/resource\/bipolardisorder\/cme\">http:\/\/www.medscape.org\/resource\/bipolardisorder\/cme<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>An irritable, inattentive, and disruptive child: Is it ADHD or bipolar disorder? &nbsp;<a href=\"http:\/\/www.currentpsychiatry.com\/articles\/evidence\u2010based\u2010reviews\/article\/an\u2010irritable\u2010 inattentive\u2010and\u2010disruptive\u2010child\u2010is\u2010it\u2010adhd\u2010or\u2010bipolar\u2010 disorder\/d16f8a9a80bf98ec962f55543850fca6.html\">http:\/\/www.currentpsychiatry.com\/articles\/evidence\u2010based\u2010reviews\/article\/an\u2010irritable\u2010 inattentive\u2010and\u2010disruptive\u2010child\u2010is\u2010it\u2010adhd\u2010or\u2010bipolar\u2010 disorder\/d16f8a9a80bf98ec962f55543850fca6.html<\/a><\/li>\n\n\n\n<li>The child bipolar questionnaire: A dimensional approach to screening for pediatric bipolar disorder <a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0165032706001741\">http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0165032706001741<\/a><\/li>\n\n\n\n<li>Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14754775\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14754775<\/a><\/li>\n\n\n\n<li>Validity of the Parent Young Mania Rating Scale in a Community Mental Health Setting <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3004712\">http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3004712<\/a><\/li>\n\n\n\n<li>Florida behavioral health center: <a href=\"https:\/\/url.us.m.mimecastprotect.com\/s\/_N1WCJ6j7mUNW3lSVfWhy88w-?domain=floridabhcenter.org\">https:\/\/floridabhcenter.org\/wp-content\/uploads\/2021\/02\/Bipolar-Disorders_Adult-Guidelines-2019-2020.pdf<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-esab-accordion-child\"><div class=\"esab__head\" role=\"button\" aria-expanded=\"false\"><div class=\"esab__heading_txt\"><p class=\"esab__heading_tag\">References<\/p><\/div><div class=\"esab__icon\"><div class=\"esab__collapse\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m3.5 20.5c-4.7-4.7-4.7-12.3 0-17 4.7-4.7 12.3-4.7 17 0 4.6 4.7 4.6 12.3 0 17-4.7 4.6-12.3 4.6-17 0zm0.9-0.9c4.2 4.2 11 4.2 15.2 0 4.2-4.2 4.2-11 0-15.2-4.2-4.3-11-4.3-15.2 0-4.3 4.2-4.3 11 0 15.2z\"><\/path><path d=\"m11.4 15.9v-3.3h-3.3c-0.3 0-0.6-0.3-0.6-0.6 0-0.4 0.3-0.6 0.6-0.6h3.3v-3.3c0-0.3 0.3-0.6 0.6-0.6 0.3 0 0.6 0.3 0.6 0.6v3.3h3.3c0.3 0 0.6 0.2 0.6 0.6q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2h-3.3v3.3q0 0.2-0.2 0.4-0.2 0.2-0.4 0.2c-0.4 0-0.6-0.3-0.6-0.6z\"><\/path><\/svg> <\/div><div class=\"esab__expand\"> <svg version=\"1.2\" viewBox=\"0 0 24 24\" width=\"24\" height=\"24\"><path fill-rule=\"evenodd\" d=\"m12 24c-6.6 0-12-5.4-12-12 0-6.6 5.4-12 12-12 6.6 0 12 5.4 12 12 0 6.6-5.4 12-12 12zm10.6-12c0-5.9-4.7-10.6-10.6-10.6-5.9 0-10.6 4.7-10.6 10.6 0 5.9 4.7 10.6 10.6 10.6 5.9 0 10.6-4.7 10.6-10.6z\"><\/path><path d=\"m5.6 11.3h12.8v1.4h-12.8z\"><\/path><\/svg> <\/div><\/div><\/div><div class=\"esab__body\">\n<ul class=\"wp-block-list\">\n<li>American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC, American Psychiatric Association.<\/li>\n\n\n\n<li>American Academy of Child and Adolescent Psychiatry. Practice parameters for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:107-125.<\/li>\n\n\n\n<li>Medscape.com: <a href=\"https:\/\/www.medscape.com\/viewarticle\/screening-bipolar-disorder-primary-care-2024a1000f24?_gl=1*icdpx5*_gcl_au*MTIwNDczNDg3MS4xNzUwNjM3MzY2\">https:\/\/www.medscape.com\/viewarticle\/screening-bipolar-disorder-primary-care-2024a1000f24?_gl=1*icdpx5*_gcl_au*MTIwNDczNDg3MS4xNzUwNjM3MzY2<\/a><\/li>\n\n\n\n<li>Massachusetts Child Psychiatry Access Program: <a href=\"https:\/\/www.mcpap.com\/Provider\/BipolarDisorder.aspx\">https:\/\/www.mcpap.com\/Provider\/BipolarDisorder.aspx<\/a><\/li>\n\n\n\n<li>National Institute of health: <a href=\"https:\/\/search.usa.gov\/search?utf8=%E2%9C%93&amp;affiliate=nih&amp;query=pediatric+bipolar+Disorder&amp;commit=\">https:\/\/search.usa.gov\/search?utf8=%E2%9C%93&amp;affiliate=nih&amp;query=pediatric+bipolar+Disorder&amp;commit=<\/a><\/li>\n\n\n\n<li>Oregon psychiatric access line:<br><a href=\"https:\/\/www.ohsu.edu\/sites\/default\/files\/2019-10\/OPAL-K%20Bipolar%20Disorder%20Care%20Guide%20v10.2019.pdf\">https:\/\/www.ohsu.edu\/sites\/default\/files\/2019-10\/OPAL-K%20Bipolar%20Disorder%20Care%20Guide%20v10.2019.pdf<\/a><\/li>\n\n\n\n<li>Stahl SM. Stahl\u2019s Essential Psychopharmacology:<br>Neuroscientific Basis and Practical Applications, 3rd Ed. New York: Cambridge University Press; 2008.<\/li>\n<\/ul>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Bipolar disorder is one of the more serious psychiatric illnesses, with a lifetime prevalence of 2.4%. For up to half of the people with bipolar disorder, the illness begins at less than 13 years of age (very-early-onset bipolar disorder) or between 13 and 18 years of age (early-onset bipolar disorder). Early-onset versus late-onset bipolar disorder [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":1210,"parent":1026,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-full.php","meta":{"footnotes":""},"class_list":["post-1208","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Bipolar Disorder - ACCESS Mental Health for Youth<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.accessmhct.com\/youth\/resources-2\/provider-toolkit\/bipolar-disorder\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Bipolar Disorder - ACCESS Mental Health for Youth\" \/>\n<meta property=\"og:description\" content=\"Bipolar disorder is one of the more serious psychiatric illnesses, with a lifetime prevalence of 2.4%. 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