Collaborative Role of the Pediatrician in the Diagnosis and Management of Bipolar Disorder in Adolescents

Abstract

Despite the complexity of diagnosis and management, pediatricians have an important collaborative role in referring and partnering in the management of adolescents with bipolar disorder. This report presents the classification of bipolar disorder as well as interviewing and diagnostic guidelines. Treatment options are described, particularly focusing on medication management and rationale for the common practice of multiple, simultaneous medications. Medication adverse effects may be problematic and better managed with collaboration between mental health professionals and pediatricians. Case examples illustrate a number of common diagnostic and management issues.

Suicide and Suicide Attempts in Adolescents

“…The American Academy of Pediatrics (AAP) provides more information about adolescent bipolar disorder and the role of the pediatrician in screening, diagnosis, and management. 57 At well-adolescent visits, adolescents who show any evidence of psychosocial or adaptive difficulties should be assessed regularly for mental health concerns and also asked about suicidal ideation, physical and sexual abuse, bullying, substance use, and sexual orientation. Depression screening is now recommended for all adolescents between the ages of 11 and 21 years of age in the third edition of Bright Futures.…”

Arterial Hypertension and Posterior Reversible Cerebral Edema Syndrome Induced by Risperidone

“…4,16 Very rarely, these agents paradoxically produce high blood pressure. 7,16 Most cases of hypertension associated with these agents occur in patients who are overweight or being concurrently treated with selective serotonin reuptake inhibitors.…”

“…Periods of abnormally elevated and irritable mood lasting 8 to 10 days associated with a decreased need for sleep and her attention being easily drawn to insignificant external stimuli had also been reported. Based on these data, the diagnosis of bipolar type I disorder 4 was made, and oral risperidone 0.75 mg twice daily was started when she was 10 years old. No adverse effects were noted, and her parents reported improved health-related quality of life, scholarly activities, and social interactions.…”