Introduction and Overview

The following resources are widely used in clinical settings to screen and assess, design treatment protocol, prescribe medication and provide referrals for children and adolescents with symptoms of Bipolar Disorder.


Screening & Assessment

Considering Bipolar Disorder

Flowchart to guide the process of considering, diagnosing, and treating bipolar disorders.

 

Abnormal Involuntary Movement Scale (AIMS)

Physical exam to assess for Tardive Dyskinesia symptoms. Tardive Dyskinesia causes abnormal movements. Symptoms can be a result of antipsychotic medications.

 


Treatment

 Evidence-Based Treatments for Bipolar Disorder


Referral and Co-Management

NA for this topic


Medication

  • Comes in: 0.5, 1, 2, 3, 4 mg 1mg/ml
  • Start at: 0.5 mg
  • Titration schedule to effect: Dose may be adjusted if needed, in increments of 0.5 to 1 mg/day at intervals ≥24 hours, as tolerated, to a dose of 2.5 mg/day. Note: May administer 1/2 the daily dose twice daily in patients who experience persistent somnolence.
  • FDA approved for age ≥ 10

  • Comes in: 2, 5, 10, 15, 25, 30 mg 1mg/ml
  • Start at: 2 mg QD
  • Titration schedule to effect:
  • Most common dose range:  Max Daily Dose:
  • FDA approved for age ≥ 10

  • Comes in: 25, 50, 100, 200, 300, 400 mg
  • Start at: 22 mg BID
  • Titration schedule to effect:
  • Most common dose range:  Max Daily Dose:
  • FDA approved for age ≥ 10

  • Comes in: 20, 40, 60, 80 mg
  • Start at: 20 mg BID
  • Titration schedule to effect:
  • Most common dose range:  Max Daily Dose:
  • Not approved by the FDA

  • Comes in: 2.5, 5, 7.5, 10, 15, 20 mg
  • Start at: 2.5 mg QHS
  • Titration schedule to effect:
  • Most common dose range:  Max Daily Dose:
  • FDA approved for age ≥ 13

  • Comes in: Sublingual 2.5, 5, 10 mg
  • Start at: 2.5 mg SL BID
  • Titration schedule to effect:
  • Most common dose range:  Max Daily Dose:
  • FDA approved for age ≥ 10

  • Comes in: 20, 40, 60, 80, 120 mg
  • Start at: 20 mg QD
  • Titration schedule to effect:
  • Most common dose range:  Max Daily Dose:
  • FDA approved for age ≥ 10

  • Lithium: FDA aprroved age ≥ 7
  • Valproate: Not approved by the FDA
  • Carbamazepine: Not approved by the FDA
  • Lamotrigine: Not approved by the FDA

Billing/Coding

  • Can code two per visit
  • Code pays $7.91 (at well visit and at E+M visit)
    • Examples: Bright Futures Adolescent Supplemental Questionnaire, GAPS, HEADSSS

  • Can code two per visit
  • Code pays $4.10 (at well visit and at E+M visit)
    • Examples: PSC, SCARED, CDI, CES-DEC, PHQ-9 Modified for Adolescents, Vanderbilt, Conners

  • May be reported in addition to E/M or Health Check
  • Code pays $30.73 (only code if screen is positive & counseling is documented from 3-15 minutes)
    • Examples: CRAFFT for Substance Use/Abuse

Additional Resources for Families

There is no shortage of books written about childhood bipolar disorder. Despite this fact, quality research based and balanced information is hard to find. This reflects a professional debate about how bipolar disorder in children is defined, with some authors using “bipolar, unspecified type” as a label for a very irritable child.

Families should start their learning about bipolar disorder with the following websites that provide high quality information and support.

  • iMoodJournal: Daily mood tracking
  • Breathe2Relax: Guided deep breathing
  • eMoods: This app was designed for people with bipolar disorder to capture daily highs, lows, symptoms, etc., to track mood changes and see monthly reports, identify triggers, and improve care.
  • Medisafe: Medication tracking/reminders.

  • An Unquiet Mind (1995), by Kay Redfield Jamison, MD (a memoir by a bipolar disorder researcher who had the illness herself — can be helpful for understanding the nature of bipolar disorder)
  • Bipolar Disorder for Dummies (2005), by Candida Fink, MD and Joe Craynak (don’t be put off by the name of the book, it is balanced and easy to read)
  • The Bipolar Workbook: Tools for controlling your mood swings (2006), by Monica Ramirez Basco (contains some practical advice, based on CBT principles)
  • Your Child Does Not Have Bipolar Disorder (2011) by Stuart Kaplan (describes when a bipolar label would not be appropriate, and how we know how to help irritable, angry, explosive children)
  • The Bipolar Teen: What You Can Do to Help Your Child and Your Family (2007), by David Miklowitz, PhD and Elizabeth George, PhD