Evidence-based assessment/Rx4DxTx of bipolar in youths
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Resources for the Assessment and Treatment of Bipolar Disorders in Children and Adolescents[edit | edit source]
Pediatric bipolar disorder (PBD) has been acknowledged by clinicians and researchers alike for centuries, but the diagnosis of Bipolar Disorder in children has historically been controversial. There is a long-standing debate over whether or not bipolar disorder (BD) should be diagnosed in children at all, and if it should, at what age is it appropriate to begin to diagnose children with the disorder. According to meta-analytic evidence, the community prevalence of PBD is 3.9%, without a significant increase in prevalence over time. There is large variability demonstrated within the symptom presentation of children with PBD, partly due to the fact that BD is a "spectrum" of disorders with no clear qualitative boundaries separating the different types (i.e., BD-I, BD-II, cyclothymia, and Other Specified Bipolar and Related Disorder)identified by current classification systems. To combat this variability within symptoms and allow for a concrete diagnosis, it is important to evaluate the most appropriate plan for assessment, diagnosis, and treatment while also keeping in mind the risk factors and long-term prognosis for children with PBD.
This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rates of PBD that they are likely to see in their clinical practices.
- To find prevalence rates across multiple disorders, click here.
p Parent interviewed as component of diagnostic assessment; y youth interviewed as part of diagnostic assessment.
Note: KSADS = Kiddie Schedule for Affective Disorders and Schizophrenia, PL = Present and Lifetime version, WASH-U = Washington University version, -E = Epidemiological version of the KSADS; DISC = Diagnostic Interview Schedule for Children; DICA = Diagnostic Interview for Children and Adolescents. Table modified from Wikiversity.
|Demography||Setting||Base Rate||Diagnostic Method|
|All of U.S.A.||Community epidemiological
|U.S.A., Netherlands, U.K., Spain, Mexico, Ireland, New Zealand||Community epidemiologic samples||mean= 1.8% (95% CI, 1.1%–3.0%), bipolar I (mean =1.2%; 95% CI, 0.7%–1.9%)||Structured and semi-structured diagnostic interviews, Combination of broad and specific diagnostic criteria (Meta-Analysis)|
|U.S.A., Midwestern Urban, 80% non-white, low-income||Community mental health center||6%||Parent and youth clinical assessment & treatment|
|Urban academic research centers||General outpatient clinic||6-8%||WASH-U-KSADS (parent and youth)|
|Boston area, U. S. A.||Specialty outpatient service||15-17%||KSADS-E|
|All of Germany||Inpatient Services/Diagnoses||0.3%||International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)|
|Oregon||Community sample||2.9%||LIFE, SCID, DSM-IV|
|New York City Metro Region||Inpatient service||30% manic symptoms, <2% strict BP I||DICA; KSADS|
|U.S.A, NCS-A||NCS-A Clinical Reappraisal Sample p y||6.2% and SE=1.7 (bipolar I and II and sub-threshold bipolar spectrum disorder)||K-SADS, DSM-IV
criteria were modified from published version for purpose of the study, broad criteria for not otherwise specified
|U.S.A, NCS-A||NCS-A Clinical Reappraisal Sample p y||6.6% and SE=1.7 (bipolar I and II and sub-threshold bipolar spectrum disorder)||CIDI, DSM-IV criteria were modified from published version for purpose of the study, broad criteria for not otherwise specified,|
|United Kingdom||National Cross‐sectional epidemiological sample p y||1.2% (bipolar I and II and not otherwise specified)||DAWBA, DSM-IV criteria, broad criteria for not otherwise specified|
|Mexico City||Community epidemiological samples y||2.5% (bipolar I and II)||CIDI, DSM-IV Criteria|
|Ireland||2-stage epidemiological study p y||0.0% (bipolar I and II, cyclothymia, not otherwise specified||K-SADS, DSM-IV Criteria|
p:Parent interviewed as component of diagnostic assessment; y:Youth interviewed as part of diagnostic assessment.
- KSADS = Kiddie Schedule for Affective Disorders and Schizophrenia,
- WASH-U = Washington University version, -PL = Present and Lifetime Version, -E = Epidemiological version of the KSADS
- LIFE = Longitudinal Interval Follow-Up Evaluation,
- DICA = Diagnostic Interview for Children and Adolescents
- CIDI = Composite International Diagnostic Interview
- DAWBA= The Development and Well-Being Assessment
Diagnostic Criteria, Prevalence, and Comorbidity[edit | edit source]
Diagnostic Criteria[edit | edit source]
Click here for Bipolar Disorder diagnostic criteria
The DSM-5 and ICD-11 provide diagnostic criteria for BD that are used by clinicians in the assessment of both adults and youth. The diagnostic criteria for PBD is similar to that used to assess BD in adults, with minor variations to address changes in development. For adults and children alike, there are four classifications of BD: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and Other Specified Bipolar and Related Disorder.  The table below describes the core features of bipolar disorder.
Table: Symptoms and associated features of BSD based on meta-analysis
a Sensitivity estimates from Van Meter, Burke, Kowatch, et al. (2016) meta-analysis.
A bipolar I disorder diagnosis requires the patient to have at least one manic episode within their lifetime. Manic episodes are best described as a period of extreme elated mood/energy and irritability, and individuals must experience three or more of the symptoms provided; among the most commonly experienced are grandiosity, racing thoughts, decreased/dysfunctional sleep, and being easily distracted . Major depressive episodes are common but not required for a diagnosis of bipolar disorder. Major depressive episodes are characterized by a period of either anhedonia or depressed mood in addition to having five or more of the classified symptoms within a period of 2 weeks such as lack of sleep, fatigue, worthlessness, or suicidal ideation. To be diagnosed with bipolar II disorder, a patient must demonstrate at least one hypomanic episode paired with at least one major depressive episode. The criteria are still the same for a depressive episode, but a hypomanic episode is a change in mood present for at least 4 consecutive days for a majority of the day. Three or more of the similar symptoms experienced for manic episodes are required. The DSM-5 specifies manic, hypomanic, and depressed as the three types of episodes of BD.
Table: Criteria for Manic or Hypomanic Episode
Cyclothymic disorder occurs when the patient experiences hypomanic episodes and depressive episodes (but not major depression) over a period of 2 years.
One of the symptoms most commonly experienced by children with pediatric bipolar disorder is irritability. This is observed during manic/hypomanic episodes. Although it is a distinct symptom of bipolar disorder, it is also a symptom of other psychological disorders such as ADHD or conduct disorder. If irritability is absent as a symptom for the patient and no other significant risk factors are present, bipolar disorder can be ruled out.. Grandiosity, or a heightened feeling of importance, is another major symptom for BD, but a large proportion of children with PBD do not experience this symptom.
Though the DSM-5 is typically used in the United States for diagnosing pediatric patients with bipolar disorder, the most recent edition of the ICD-11 can also be utilized. Like DSM-5, ICD-11 classifies bipolar disorders into bipolar I and bipolar II; however, the BD specifier of ‘mixed episode’ is still presented in ICD-11,. The DSM-5 changed the symptoms of ‘mixed episodes’ to be classified as a ‘mixed features’ specifier. The diagnosis of bipolar I disorder can also be validated by ICD-11, but it is questionable whether bipolar II disorder represents a subset of bipolar I disorder, but with more emphasis on depressive episodes.
Prevalence[edit | edit source]
A recent meta-analysis estimated the prevalence rate of PBD overall as 3.9% (when BD is defined as a spectrum diagnosis). Although this represents an increase in the rate as compared to an earlier meta-analysis's prevalence rate of 1.8% , this may be the result of a shift from the DSM-IV to the DSM-5 and subsequent changes to diagnostic specificity. It is also consistent with prevalence rates of other recent meta-analyses. Compared to the overall rate, Bipolar I has a prevalence rate of of 0.6%.  These rates indicate that bipolar disorder in youth is more common than autism and schizophrenia but not more common than ADHD or unipolar depression. 
Another study compared diagnostic rates of PBD in the United States to other countries and identified that U.S. children are just as likely to be diagnosed with PBD as children in any other country. This suggests that cultural and ethnic factors do not present risk factors for PBD or biases in the interpretation of bipolar symptoms. Older adolescents also have significantly higher prevalence rates compared to pre-pubertal youth. 
Sex Differences[edit | edit source]
Studies of Bipolar I in adults have demonstrated that it occurs equally in men and women.  No significant differences in PBD prevalence based on gender have been demonstrated after accounting for the fact that generally, more young males present to clinics for externalizing problems than females , although earlier studies have reported a higher percentage of females with bipolar II disorder than males.
Common Comorbidities[edit | edit source]
Many symptoms of PBD overlap with symptoms of other diagnoses that are common in childhood (e.g., ADHD, conduct disorder, oppositional defiant disorder), and bipolar disorder is often comorbid with other conditions. Comorbid psychopathology may also exacerbate bipolar symptoms in pediatric patients, complicating accurate diagnosis. A meta-analytic study investigating the phenomenology of mania in children, including the most common comorbidities, determined that ADHD is the most common comorbid diagnosis (62% of participants) in children with PBD, followed by Oppositional Defiant Disorder (ODD; 53%), psychosis (42%), and anxiety (27%).
In addition to being commonly comorbid, overlapping symptoms between PBD and ADHD include irritability, distractibility, and impulsivity. When pediatric patients are diagnosed with both ADHD and PBD, they may be more susceptible to an increased severity of shared symptoms. One study investigated the effect a comorbid diagnosis of both ADHD and bipolar spectrum disorder (BPSD) had on pediatric patients when compared to pediatric patients with only BD. When pediatric patients were diagnosed with both ADHD and BPSD, they were more likely to experience decreased overall functioning and increased severity of symptoms. Patients with both ADHD and BPSD also experienced higher rates of additional comorbidities when compared to patients with only BPSD or ADHD alone. Age of onset did not differ between the BPSD only group and the combination of ADHD and BPSD.
There have also been cases of patients with PBD and comorbid Autism Spectrum Disorder (ASD). Researchers have studied individuals diagnosed with ASD and experiencing bipolar symptoms to investigate neurocognitive and clinical impairment compared to individuals only with ASD,  and discovered that the ASD + BD group experienced an increased rate of externalizing behaviors (e.g., aggression, delinquency) and behavioral inhibition. The ASD + BD group also experienced increased internalizing behaviors such as depression, suicidal ideation, and anxiety.
Prognosis or Developmental Course[edit | edit source]
Because the bipolar symptoms pediatric patients experience can be variable and unpredictable in nature (especially in terms of duration and frequency), it is difficult to determine if there is a concrete age of onset for PBD. According to a study by Leverich et al. (2007), when surveying 480 individuals with bipolar disorder, 14% reported their age of onset was between 0-12 years old, with the average age around 9.57. Patients with earlier onset of PBD were reported to have the highest incidence of parental history of depression and/or BD and greater environmental stressors. Earlier onset of bipolar disorder corresponded with longer time to treatment. Additionally, adult patients with earlier onset experienced a more convoluted developmental course of BD, including faster cycling periods, substance abuse, depressive episodes, and suicide attempts, demonstrating the importance of early intervention for PBD.
The family environment of a child with PBD can also affect overall functioning and symptom severity. Pediatric patients that experience greater impairment in a variety of contexts (at home, in school, and other social settings) are more likely to have reduced overall functioning, a history of being admitted to a mental health institution, and/or a suicide attempt. Additionally, reduced functional and social impairment for children with PBD can ultimately lead to a reduced quality of life. Cotrena et al. (2020) measured the value of ‘quality of life’ (QoL) for patients with PBD based on how their personal QoL (how they view their lives) and social QoL (how they perceive the world) compared to how the patient managed their depression symptoms and their PBD diagnosis, and both were found to negatively affect outcomes. In particular, such factors (which factors?) influenced one’s personal QoL and cognitive performance. Because the presence of manic and depressive symptoms can impair function and, consequently, cognitive performance, children with PBD may experience lower self-esteem and reduced quality of life compared to healthy children.
Evidence-Based Assessment[edit | edit source]
PBD is considered a spectrum disorder, suggesting that children with PBD are likely to experience a range of symptoms. This can make PBD especially difficult to diagnose and, consequently, treat. Establishing a clear and well-defined assessment strategy for clinicians to use can provide a more accurate and reliable way to diagnose PBD and prevent misdiagnoses. Clinicians are recommended to use screening questions as an initial step in evidence-based assessment (EBA). Screening questions allow the clinician to gauge if the patient has had spontaneous changes in mood for defined periods of time and assess personal and family history of mood disorders. Symptom reports from family members, school, and peers are necessary to gauge the behavioral and emotional challenges a child is experiencing. Other potential medical conditions or comorbid disorders must be reported to determine the most appropriate treatment plan, especially if there is a presence of suicidal ideation and/or substance abuse. Following the screening, the use of a questionnaire and checklists are the next logical step in EBA.
Questionnaires like K-SADS, WASH-U-KSADS, and the Young Mania Rating Scale are pivotal for determining mania severity as well as feedback for treatment, but not for diagnosing a patient with PBD. One of the most effective assessment checklists for diagnosis is the Achenbach System of Empirically Based Assessment (also Child Behavior Checklist, CBCL). The CBCL represents a pediatric patient’s symptoms on a scale, conveying both externalizing and internalizing symptoms. The CBCL shows a higher sensitivity for externalizing scores for PBD, which is helpful in differentiating PBD from other disorders like ADHD. Such measures indicate what the appropriate approach for treatment is as well as the patient’s overall functioning level. However, in general, questionnaires are observed to be more effective when paired with a diagnostic structured interview.
Bayesian approaches, or nomograms, may also be used with checklists or questionnaires. Bayesian approaches identify the probability that a patient has a certain disorder using a patient's diagnostic likelihood and their test results on performance-based exams. The nomogram allows clinicians to create probabilities that are unbiased, efficient, and produce no variability, reducing the chance that PBD would be misdiagnosed.
Table: Recommended starter kits for assessing potential bipolar spectrum disorder
Note. Bipolar Disorder is extremely rare before the age of 5; do not consider as a possible diagnosis except under highly extenuating circumstances.
Glossary: YSR = Youth Self Report; BASC = Behavioral Assessment Scale for Children; SDQ = Strengths and Difficulties Questionnaire; ASI = Adolescent Symptom Inventory; CSI = Child Symptom Inventory; YASR = Young Adult Self-Report; PPDS = Petersen Pubertal Developmental Screen; FIRM = Family Index of Risk for Mood disorders; GBI = General Behavior Inventory; 7 Up = 7 Up; PGBI-10M, 10Da, 10Db = 10 item forms of parent-reported GBI; HCL = Hypomania Checklist; BSDS = Bipolar Spectrum Diagnostic Scale; MDQ = Mood Disorder Questionnaire; ISS = Internal States Scale; MINI = Mini International Neuropsychiatric Interview; MINI-Kid = MINI for Children and Adolescents; KMRS = KSADS Mania Rating Scale; KDRS = KSADS Depression Rating Scale; YMRS = Young Mania Rating Scale; HDRS = Hamilton Depression Rating Scale; CGAS = Children’s Global Assessment Scale; GAF = Global Assessment of Functioning; KINDL = quality of life scale (not an acronym); QoL.BSD = Quality of Life for Bipolar Disorder; PGBI Sleep = sleep scale carved from parent GBI; SMEQ = Student Morningness-Eveningness Questionnaire; PSQI = Pittsburgh Sleep Quality Index.
Online Assessment Resources[edit | edit source]
There are a number of online assessment resources available for the general public (adolescents, parents, etc.) as well as clinicians. The Helping Give Away Psychological Science (HGAPS) Assessment Center offers a free, confidential platform to help you safely explore your mental health symptoms and determine if you should seek assistance from a mental health professional. Upon finishing an assessment, you will be given your results and offered recommended resources based on the symptoms you have endorsed.
The following links are to specific assessment batteries for adults, adolescents, and caregivers:
This survey contains self-report assessments used by mental health professionals to measure ADHD, depression, anxiety, PTSD, bipolar disorder, and substance use in adults. These questionnaires are designed to be taken by an adult about themselves.
This survey contains self-report assessments used by mental health professionals to measure depression, anxiety, PTSD, bipolar disorder, substance use, and oppositional defiant disorder/conduct disorder in youth. These questionnaires are designed to be taken by a child or adolescent about themselves.
This survey contains assessments used by mental health professionals to measure ADHD, depression, anxiety, PTSD, bipolar disorder, substance use, and oppositional defiant disorder/conduct disorder in youth. These questionnaires are designed to be taken by a caregiver about a child or adolescent.
The HGAPS Assessment Center also offers specific measures for clinician use.
|7 Up-7 Down||English||Adult and Adolescent||7up-7down|
|BSDS: Bipolar Spectrum Diagnostic Scale||English||Adult||BSDS|
|CMRS: Child Mania Rating Scale||English||Parent||CMRS|
|Family Index of Risk for Mood (FIRM)||English||Parent||FIRM|
|Hypomania Checklist (HCL)||English||Adult||HCL|
|General Behavior Inventory||English||Parent||GBI|
|General Behavior Inventory||Spanish||Parent||GBI|
|General Behavior Inventory||English||Adult/Adolescent||GBI|
|General Behavior Inventory 10M||English||Parent||GBI 10M|
|General Behavior Inventory Da||English||Parent||GBI Da|
|General Behavior Inventory Da||Spanish||Parent||GBI Da|
|General Behavior Inventory Db||English||Parent||GBI Db|
Evidence-Based Treatment[edit | edit source]
After a child or adolescent has received a comprehensive, evidence-based assessment and is diagnosed with PBD, the clinician should devise the most appropriate evidence-based treatment plan specific to the patient. There are numerous treatment options for PBD, and research has demonstrated efficacy in pharmacotherapy, psychotherapy, and the combination of the two.
Medication[edit | edit source]
Medication is often the first line of treatment for children and adults with BD, though current recommendations suggest a combination of medication and therapy is most effective (Look at review by Kowatch; AACAP practice parameters- need EAY to send to JJ; Correll has meta-analyses about efficacy and side effects). Before medication is prescribed to pediatric patients, their medical history and the possibility of comorbidity must be considered. Lithium can only be prescribed to children who are 12 years of age or older. Lithium and Divalproex have been recommended as a first line for treatment, specifically for nonpsychotic manic episodes. A combination of medications such as lithium with Divalproex or lithium with an atypical antipsychotic can also be efficacious, but typically this treatment approach is only used if the use of a singular medication is unsuccessful. Overall, patients who are prescribed medication must be thoroughly monitored for adverse side effects (especially for lithium, which can be toxic if blood lithium levels are too high).
Mood Stabilizers[edit | edit source]
Lithium[edit | edit source]
Though there are variety of pharmacological treatment options for BD, lithium is a commonly used mood stabilizer. According to Harrison et al. (2016), lithium is the most effective treatment to prevent relapse of mood episodes. Lithium works by inhibiting inositol monophosphate and other enzymes signaling to calcium channels, inhibiting mitochondrial function, and G-protein activated potassium channels. Lithium use must be carefully monitored, because there is a delicate balance between a dosage that is helpful and one that is toxic or even deadly .
A meta-analysis completed by Nolen et al. (2019) found that optimal lithium dosages were around the lower end of 0.45-0.60 mmol/L and the higher end of 0.80-1.00 mmol/L. Individuals at the higher end of dosage (0.80-1.00 mmol/L) relapsed more often than those in the lower end of dosage . Patients who were given less than 0.45 mmol/L had a relapse rate of 61.5%, demonstrating that there is a minimum dosage in which lithium can be effective. Patients outside the two ranges did not see any benefit, especially if the individual was prescribed more than 1.00 mmol/L .
Lithium is a popular pharmacological treatment option because it can prevent mood episodes from reoccurring in patients with BD. Lithium may prevent manic episodes and decrease the risk of suicide (a notable benefit given that BD has one of the highest suicide rates in comparison to the general population) . A study by Song et al. (2017) demonstrated a 14% decrease in suicide-related events (in patients with BD?) in comparison to a group with BD that was not receiving lithium (were they receiving anything else?). Because lithium may reduce manic episodes, it may subsequently reduce impulsivity. Decreased impulsivity can lead to decreased rates of self-harm in individuals with BD .
Though lithium's effectiveness makes it a frontline treatment for BD, it may also be a dangerous treatment option. The thyroid, kidneys, and the parathyroid glands are three large and important organ systems that may sustain damage from lithium intake . Most people experience mild side effects when actively taking lithium, all of which are related to organ damage over time. For example, lithium use can structurally damage kidney tubules, resulting in polyuria (increased urination) . Symptoms of lithium toxicity must be closely monitored, and dosages of lithium must be adjusted based on a person’s sensitivity.
Lithium is widely used for BD treatment in adults, but its use in children is understudied. CoLT studies have found an optimal dosage in children of 0.3 and 1.3 mEq/L, which is much lower than the dosage for adults . In another research study in children with BD, some children who were taking lithium achieved remission. Those who were not considered "in remission" experienced stabilization of symptoms, a promising direction for future research .
Anticonvulsants (Antiepileptic Agents)[edit | edit source]
Antiepileptic agents are used for the treatment of BD in both youth and adults. The specific antiepileptic agents that have been studied in children and adolescents with BD are carbamazepine, divalproex sodium, lamotrigine, oxcarbazepine, and topiramate .
Antipsychotics[edit | edit source]
Antipsychotics (also known as neuroleptics) may be used in conjunction with lithium when someone is undergoing an acute, severe manic episode. However, there are concerns over neurotoxicity with a prolonged use of lithium and antipsychotics together . The FDA has approved antipsychotics for treatment of BD, mania and mixed states, and as maintenance to treat depressive, manic or mixed episodes. A common practice is also to use antipsychotics over a prolonged period. However, antipsychotics may cause several undesired side effects such as weight gain, late dyskinesia, sedation, sexual dysfunction and depression. Antipsychotics may be further classified into typical or atypical.
First Generation Antipsychotics (FGA; "Typical")[edit | edit source]
Typical antipsychotics, or first generation antipsychotics, are useful in treating manic symptoms even in the absence of psychotic symptoms. However, their use has drastically decreased in the treatment of BD due to the risk of extrapyramidal symptoms (drug-induced movement disorders). 
Second Generation Antipsychotics (SGA; "Atypical")[edit | edit source]
Atypical antipsychotics, or second generation antipsychotics, are equally effective as typical antipsychotics in the treatment of manic symptoms, but they do not cause extrapyramidal symptoms. Since 2000, there have been several aytipcal psychotics that have been approved for treatment by the FDA. Olanzapine (generic form available) was approved in 2000, Risperidone was approved in 2003, Quetiapine, Aripiprazole, and Ziprasidone were approved in 2004, Olanzapine/fluoxetine combination was approved in 2012, Lurasidone was approved in 2013, and Cariprazine and Asenapine were approved in 2015.
Sedatives[edit | edit source]
Antidepressants[edit | edit source]
Depressive episodes within patients with BD are often difficult to treat pharmacologically, because elevating mood via antidepressants may lead to manic episodes.
[edit | edit source]
Another approach to treatment is psychosocial therapy. Cognitive-behavioral therapy (CBT) emphasizes the psychosocial factors of PBD and helps the pediatric patient change their thinking patterns and learn coping skills to manage their cognitions and emotions. An adaption of combined family-focused treatment and CBT called Child- and Family-Focused CBT (CFF-CBT), or the RAINBOW program, was established specifically for children with PBD between the ages of 8-12 and their families. This 12-session program focuses on teaching parents and children self-efficacy and behavioral management, engaging problem-solving skills, and increasing or maintaining social support. CBT and its many variations may be useful to help families and children learn to manage bipolar disorder as well as reduce the negative conflict and affect likely existent within a household.
Interpersonal Social Rhythms Therapy (IPSRT) has also been demonstrated as an effective treatment for adolescents with PBD, specifically to manage symptoms related to sleep dysfunction. IPSRT can help youth stabilize their moods, improve social functioning, and regulate their sleep patterns. It can also help clinicians establish the relationship between the beginning of mood episodes and sleep dysfunction patterns. When combined with medication, IPSRT has been shown to increase time between mood episodes.
|Child- and Family-Focused Cognitive-Behavioral Therapy||
|Interpersonal and Social Rhythm Therapy||
||Varies dependent on client need||
|Mindfulness-Based Cognitive Therapy||
|Multi-Family Psychoeducational Psychotherapy||Group therapy using treatment components from:
Exercise as a Treatment Component[edit | edit source]
Exercise has been credited for its tremendous benefits in cardiovascular systems, the brain, sleep, and even mood. Although it is not a first-line treatment for PBD, there may be benefits to including an exercise regimen as an adjunctive treatment with medication and/or psychotherapy. There is limited research examining exercise's benefits in PBD, but studies in adults with BD demonstrate promising results. Consequently, adults with BD tend to have more sedentary lifestyles, which may lead to increased comorbidities and depressive symptoms.
One such promising study investigated the impact of exercise on adults with BD, examining improvements in quality of life and mood symptoms. 40% of participants reported not exercising at all, and the less participants exercised (of those who did), the more likely their quality of life and overall functioning was to be lower. Consequently, exercising more often corresponded to more frequent manic symptoms and mixed episodes.
Though the above studies observe adults with BD, it is likely that exercise is associated with the same effects on mood symptoms and quality of life in children, and additionally, one’s long-term trajectory of BD into adulthood. A study of adolescents demonstrated that when adolescents with BD participate in short-term, aerobic exercise, neural activity in the nucleus accumbens is different after exercising (measured by performing an executive task both before and after exercise). This suggests for adolescents, and possibly extending into younger children, exercise can increase concentration, an impairment that is often seen in youth with PBD.
Resources[edit | edit source]
|National Institute of Mental Health||
This website includes a section for each mental disorder listed in the DSM-5. There is a section dedicated to bipolar disorder in children and teens comprised of the definition of bipolar disorder, symptoms, diagnosis, comorbidities, and common treatments.
|Effective Child Therapy||Effective Child Therapy is a resource for evidence-based information about bipolar disorder and other mental illnesses diagnosed in children.|
|National Suicide Prevention Lifeline||National Suicide Prevention Lifeline provides a hotline number (1-800-273-8255), an online chat, and an informational website for individuals who are experiencing suicidal thoughts.|
|Psychology Today||Psychology Today provides information for individuals and families who are seeking local, face-to-face therapy options for treatment of psychiatric symptoms, including treatment centers for bipolar disorder in and around Raleigh.|
|NC Health Info||NC Health Info provides additional resources including local therapists, support groups, and more that are specifically for individuals with bipolar disorder in North Carolina.|
|Depression and Bipolar Support Alliance (DBSA)||The DBSA is a non-profit organization providing support for people with bipolar disorder, their caregivers, and clinicians. Individuals can search for in-person support groups by zip code or participate in online support chats or groups.|
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- ↑ Carlson, Gabrielle A.; Glovinsky, Ira (2009-04-01). "The Concept of Bipolar Disorder in Children: A History of the Bipolar Controversy". Child and Adolescent Psychiatric Clinics of North America. Bipolar Disorder 18 (2): 257–271. doi:10.1016/j.chc.2008.11.003. ISSN 1056-4993. http://www.sciencedirect.com/science/article/pii/S1056499308001041.
- ↑ 2.0 2.1 2.2 2.3 2.4 Van Meter, A., Moreira, A. L. R., & Youngstrom, E. (2019). Updated Meta-Analysis of Epidemiologic Studies of Pediatric Bipolar Disorder.The Journal of Clinical Psychiatry,80(3), 0–0. https://doi.org/10.4088/JCP.18r12180
- ↑ Youngstrom, Eric A.; Findling, Robert L.; Youngstrom, Jen Kogos; Calabrese, Joseph R. (2005-08-01). "Toward an Evidence-Based Assessment of Pediatric Bipolar Disorder". Journal of Clinical Child & Adolescent Psychology 34 (3): 433–448. doi:10.1207/s15374424jccp3403_4. ISSN 1537-4416. PMID 16026213. https://doi.org/10.1207/s15374424jccp3403_4.
- ↑ Kessler, Ronald C.; Avenevoli, Shelli; Costello, E. Jane; Georgiades, Katholiki; Green, Jennifer Greif; Gruber, Michael J.; He, Jian-ping; Koretz, Doreen et al. (1 April 2012). "Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement". Archives of General Psychiatry 69 (4): 372–380. doi:10.1001/archgenpsychiatry.2011.160. ISSN 1538-3636. http://www.ncbi.nlm.nih.gov/pubmed/22147808. Retrieved 26 January 2016.
- ↑ Van Meter, Anna R.; Moreira, Ana Lúcia R.; Youngstrom, Eric A. (1 September 2011). "Meta-analysis of epidemiologic studies of pediatric bipolar disorder". The Journal of Clinical Psychiatry 72 (9): 1250–1256. doi:10.4088/JCP.10m06290. ISSN 1555-2101. http://www.ncbi.nlm.nih.gov/pubmed/21672501.
- ↑ Youngstrom, Eric A.; Findling, Robert L.; Youngstrom, Jen Kogos; Calabrese, Joseph R. (September 2005). "Toward an evidence-based assessment of pediatric bipolar disorder". Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 34 (3): 433–448. doi:10.1207/s15374424jccp3403_4. ISSN 1537-4416. PMID 16026213. https://www.ncbi.nlm.nih.gov/pubmed/16026213.
- ↑ Cite error: Invalid
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- ↑ Biederman, J.; Faraone, S.; Mick, E.; Wozniak, J.; Chen, L.; Ouellette, C.; Marrs, A.; Moore, P. et al. (August 1996). "Attention-deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity?". Journal of the American Academy of Child and Adolescent Psychiatry 35 (8): 997–1008. doi:10.1097/00004583-199608000-00010. ISSN 0890-8567. PMID 8755796. https://www.ncbi.nlm.nih.gov/pubmed/8755796.
- ↑ Holtmann, M.; Goth, K.; Wöckel, L.; Poustka, F.; Bölte, S. (2008). "CBCL-pediatric bipolar disorder phenotype: severe ADHD or bipolar disorder?". Journal of Neural Transmission (Vienna, Austria: 1996) 115 (2): 155–161. doi:10.1007/s00702-007-0823-4. ISSN 0300-9564. PMID 17994189. https://www.ncbi.nlm.nih.gov/pubmed/17994189.
- ↑ Olino, Thomas M.; Shankman, Stewart A.; Klein, Daniel N.; Seeley, John R.; Pettit, Jeremy W.; Farmer, Richard F.; Lewinsohn, Peter M. (1 September 2012). "Lifetime rates of psychopathology in single versus multiple diagnostic assessments: Comparison in a community sample of probands and siblings". Journal of psychiatric research 46 (9): 1217–1222. doi:10.1016/j.jpsychires.2012.05.017. ISSN 0022-3956. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411854/.
- ↑ Carlson, Gabrielle A.; Youngstrom, Eric A. (1 June 2003). "Clinical implications of pervasive manic symptoms in children". Biological Psychiatry 53 (11): 1050–1058. ISSN 0006-3223. http://www.ncbi.nlm.nih.gov/pubmed/12788250.
- ↑ 12.0 12.1 Kessler, Ronald C.; Avenevoli, Shelli; Green, Jennifer; Gruber, Michael J.; Guyer, Margaret; He, Yulei; Jin, Robert; Kaufman, Joan et al. (2009-04). "National Comorbidity Survey Replication Adolescent Supplement (NCS-A): III. Concordance of DSM-IV/CIDI Diagnoses With Clinical Reassessments". Journal of the American Academy of Child & Adolescent Psychiatry 48 (4): 386–399. doi:10.1097/chi.0b013e31819a1cbc. ISSN 0890-8567. PMID 19252450. PMC PMC3040100. http://linkinghub.elsevier.com/retrieve/pii/S0890856709600460.
- ↑ Stringaris, Argyris; Santosh, Paramala; Leibenluft, Ellen; Goodman, Robert (2009-07-22). "Youth meeting symptom and impairment criteria for mania-like episodes lasting less than four days: an epidemiological enquiry". Journal of Child Psychology and Psychiatry 51 (1): 31–38. doi:10.1111/j.1469-7610.2009.02129.x. ISSN 0021-9630. PMID 19686330. PMC PMC4286871. http://doi.wiley.com/10.1111/j.1469-7610.2009.02129.x.
- ↑ Benjet, Corina; Borges, Guilherme; Medina-Mora, Maria Elena; Zambrano, Joaquin; Aguilar-Gaxiola, Sergio (2009-04). "Youth mental health in a populous city of the developing world: results from the Mexican Adolescent Mental Health Survey". Journal of Child Psychology and Psychiatry 50 (4): 386–395. doi:10.1111/j.1469-7610.2008.01962.x. ISSN 0021-9630. http://doi.wiley.com/10.1111/j.1469-7610.2008.01962.x.
- ↑ Lynch, Fionnuala; Mills, Carla; Daly, Irenee; Fitzpatrick, Carol (2006-08). "Challenging times: Prevalence of psychiatric disorders and suicidal behaviours in Irish adolescents". Journal of Adolescence 29 (4): 555–573. doi:10.1016/j.adolescence.2005.08.011. ISSN 0140-1971. http://linkinghub.elsevier.com/retrieve/pii/S0140197105001004.
- ↑ 16.0 16.1 16.2 16.3 16.4 16.5 16.6 American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders(5th ed.).https://doi.org/10.1176/appi.books.9780890425596
- ↑ Van Meter, Anna R; Burke, Coty; Kowatch, Robert A; Findling, Robert L; Youngstrom, Eric A (2016-01-09). "Ten-year updated meta-analysis of the clinical characteristics of pediatric mania and hypomania". Bipolar Disorders 18 (1): 19–32. doi:10.1111/bdi.12358. ISSN 1398-5647. http://dx.doi.org/10.1111/bdi.12358.
- ↑ 18.0 18.1 18.2 Kowatch, R. A., Youngstrom, E. A., Danielyan, A., & Findling, R. L. (2005). Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents.Bipolar Disorders,7(6), 483–496. https://doi.org/10.1111/j.1399-5618.2005.00261.x
- ↑ "ICD-11". icd.who.int. Retrieved 2020-05-07.
- ↑ Youngstrom, Eric A; Birmaher, Boris; Findling, Robert L (2008-02). "Pediatric bipolar disorder: validity, phenomenology, and recommendations for diagnosis". Bipolar Disorders 10 (1p2): 194–214. doi:10.1111/j.1399-5618.2007.00563.x. ISSN 1398-5647. http://dx.doi.org/10.1111/j.1399-5618.2007.00563.x.
- ↑ 21.0 21.1 21.2 Youngstrom, E. A., Birmaher, B., & Findling, R. L. (2008). Pediatric bipolar disorder: Validity, phenomenology, and recommendations for diagnosis.Bipolar Disorders,10(1p2), 194–214 https://doi.org/10.1111/j.1399-5618.2007.00563.x
- ↑ 22.0 22.1 Severus, E., & Bauer, M. (2020). Diagnosing bipolar disorders: ICD-11 and beyond. International Journal of Bipolar Disorders,8(4). https://doi.org/10.1186/s40345-019-0177-5
- ↑ Renk, K., White, R., Lauer, B. A., McSwiggan, M., Puff, J., & Lowell, A. (2014). Bipolar disorder in children. Psychiatry J, 2014, 928685. https://doi.org/10.1155/2014/928685
- ↑ Goldstein, B. I., Birmaher, B., Carlson, G. A., DelBello, M. P., Findling, R. L., Fristad, M., . . . Youngstrom, E. A. (2017). The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research. Bipolar Disorders, 19, 524– 543. doi:https://doi.org/10.1111/bdi.12556
- ↑ Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder.Therapeutic Advances in Psychopharmacology,8(9), 251–269. https://doi.org/10.1177/2045125318769235
- ↑ Goodwin, F.K., & Jamison, K.R. (2007). Manic-depressive illness (2nd ed.) New York: Oxford University Press.
- ↑ Youngstrom, E. A., Morton, E., & Murray, G. (2020). Bipolar disorder. In E. A. Youngstrom, M. J. Prinstein, E. J. Mash, & R. Barkley (Eds.), Assessment of Disorders in Childhood and Adolescence (5th ed., pp. 192-244). Guilford Press.
- ↑ 28.0 28.1 28.2 Arnold, L. E., Demeter, C., Mount, K., Frazier, T., Youngstrom, E., Fristad, M., Birmaher, B., Findling, R. L., Horwitz, S., & Kowatch, R. (2011). Pediatric bipolar spectrum disorder and ADHD: Comparison and comorbidity in the LAMS clinical sample. Bipolar Disorders, 13(5–6), 509–521. https://doi.org/10.1111/j.1399-5618.2011.00948.x
- ↑ 29.0 29.1 29.2 Weissman, A. S., & Bates, M. E. (2010). Increased clinical and neurocognitive impairment in children with autism spectrum disorders and comorbid bipolar disorder. Research in Autism Spectrum Disorders, 4(4), 670–680. https://doi.org/10.1016/j.rasd.2010.01.005
- ↑ 30.0 30.1 30.2 Leverich, G. S., Post, R. M., Keck, P. E., Altshuler, L. L., Frye, M. A., Kupka, R. W., Nolen, W. A., Suppes, T., McElroy, S. L., Grunze, H., Denicoff, K., Moravec, M. K. M., & Luckenbaugh, D. (2007). The Poor Prognosis of Childhood-Onset Bipolar Disorder. The Journal of Pediatrics, 150(5), 485–490. https://doi.org/10.1016/j.jpeds.2006.10.070
- ↑ Renk, K., White, R., Lauer, B. A., McSwiggan, M., Puff, J., & Lowell, A. (2014). Bipolar disorder in children. Psychiatry J, 2014, 928685. https://doi.org/10.1155/2014/928685
- ↑ 32.0 32.1 32.2 Cotrena, C., Branco, L. D., Shansis, F. M., & Fonseca, R. P. (2020). Predictors of quality of life in bipolar disorder: A path analytical study. Psychiatry Research, 285, 112846. https://doi.org/10.1016/j.psychres.2020.112846
- ↑ 33.0 33.1 33.2 33.3 33.4 Mcclellan, J., Kowatch, R., & Findling, R. L. (2007). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(1), 107-125.
- ↑ 34.0 34.1 Youngstrom, E. A., Freeman, A. J., & Jenkins, M. M. (2009). The Assessment of Bipolar Disorder in Children and Adolescents. Child and Adolescent Psychiatric Clinics of North America, 18(2), 353–ix. https://doi.org/10.1016/j.chc.2008.12.002
- ↑ Mick, E., Biederman, J., Pandina, G., & Faraone, S. V. (2003). A preliminary meta-analysis of the child behavior checklist in pediatric bipolar disorder. Biological Psychiatry, 53(11), 1021–1027. https://doi.org/10.1016/S0006-3223(03)00234-8
- ↑ 36.0 36.1 Jenkins, M. M., Youngstrom, E. A., Washburn, J. J., & Youngstrom, J. K. (2011). Evidence-Based Strategies Improve Assessment of Pediatric Bipolar Disorder by Community Practitioners. Professional Psychology, Research and Practice, 42(2), 121–129. https://doi.org/10.1037/a0022506
- ↑ Achenbach, Thomas M.; Rescorla, Leslie (2001). Manual for the ASEBA school-age forms & profiles : an integrated system of multi-informant assessment. ASEBA. ISBN 0-938565-73-7. OCLC 964815129. http://worldcat.org/oclc/964815129.
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- ↑ Algorta, Guillermo Perez; Youngstrom, Eric A.; Phelps, James; Jenkins, Melissa M.; Youngstrom, Jennifer Kogos; Findling, Robert L. (2013-03). "An inexpensive family index of risk for mood issues improves identification of pediatric bipolar disorder.". Psychological Assessment 25 (1): 12–22. doi:10.1037/a0029225. ISSN 1939-134X. http://dx.doi.org/10.1037/a0029225.
- ↑ Depue, Richard A.; Slater, Judith F.; Wolfstetter-Kausch, Heidi; Klein, Daniel; Goplerud, Eric; Farr, David (1981). "A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: A conceptual framework and five validation studies.". Journal of Abnormal Psychology 90 (5): 381–437. doi:10.1037/0021-843x.90.5.381. ISSN 1939-1846. http://dx.doi.org/10.1037/0021-843x.90.5.381.
- ↑ Youngstrom, Eric A.; Murray, Greg; Johnson, Sheri L.; Findling, Robert L. (2013). "The 7 Up 7 Down Inventory: A 14-item measure of manic and depressive tendencies carved from the General Behavior Inventory.". Psychological Assessment 25 (4): 1377–1383. doi:10.1037/a0033975. ISSN 1939-134X. PMID 23914960. PMC PMC3970320. https://psycnet.apa.org/doiLanding?doi=10.1037/a0033975.
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- ↑ Ghaemi, Nassir S.; Miller, Christopher J.; Berv, Douglas A.; Klugman, Jeffry; Rosenquist, Klara J.; Pies, Ronald W. (2005-02-01). "Sensitivity and specificity of a new bipolar spectrum diagnostic scale". Journal of Affective Disorders. Bipolar Depression: Focus on Phenomenology 84 (2): 273–277. doi:10.1016/S0165-0327(03)00196-4. ISSN 0165-0327. http://www.sciencedirect.com/science/article/pii/S0165032703001964.
- ↑ Hirschfeld, Robert M.A.; Williams, Janet B.W.; Spitzer, Robert L.; Calabrese, Joseph R.; Flynn, Laurie; Keck, Paul E.; Lewis, Lydia; McElroy, Susan L. et al. (2000-11-01). "Development and Validation of a Screening Instrument for Bipolar Spectrum Disorder: The Mood Disorder Questionnaire". American Journal of Psychiatry 157 (11): 1873–1875. doi:10.1176/appi.ajp.157.11.1873. ISSN 0002-953X. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.157.11.1873.
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- ↑ Sheehan, David V.; Sheehan, Kathy H.; Shytle, R. Douglas; Janavs, Juris; Bannon, Yvonne; Rogers, Jamison E.; Milo, Karen M.; Stock, Saundra L. et al. (2010-03-15). "Reliability and Validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)". The Journal of Clinical Psychiatry 71 (03): 313–326. doi:10.4088/jcp.09m05305whi. ISSN 0160-6689. http://dx.doi.org/10.4088/jcp.09m05305whi.
- ↑ Axelson, David; Birmaher, Boris J.; Brent, David; Wassick, Susan; Hoover, Christine; Bridge, Jeffrey; Ryan, Neal (2003-12). "A Preliminary Study of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Mania Rating Scale for Children and Adolescents". Journal of Child and Adolescent Psychopharmacology 13 (4): 463–470. doi:10.1089/104454603322724850. ISSN 1044-5463. http://dx.doi.org/10.1089/104454603322724850.
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- ↑ Young, R. C.; Biggs, J. T.; Ziegler, V. E.; Meyer, D. A. (1978-11). "A Rating Scale for Mania: Reliability, Validity and Sensitivity". British Journal of Psychiatry 133 (5): 429–435. doi:10.1192/bjp.133.5.429. ISSN 0007-1250. http://dx.doi.org/10.1192/bjp.133.5.429.
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- ↑ 65.0 65.1 65.2 Cite error: Invalid
<ref>tag; no text was provided for refs named
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- ↑ Metcalfe, A. W. S., MacIntosh, B. J., Scavone, A., Ou, X., Korczak, D., & Goldstein, B. I. (2016). Effects of acute aerobic exercise on neural correlates of attention and inhibition in adolescents with bipolar disorder. Translational Psychiatry, 6(5): 1-8. doi:10.1038/tp.2016.85