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	Florida Best Practice Guidelines for Bipolar Disorder in Children and Adolescents The panel took up the discussion of bipolar disorder. There was significant debate regarding the phenomenology, longitudinal course, the difference between bipolar disorder in children, adolescents, and adults, and, after substantial and significant discussion, the expert panel decided to make recommendations for the use of medications in the treatment of bipolar disorder in children using only the narrow phenotype. Level 0: Careful assessment to ensure that ADHD, oppositional defiant disorder, and conduct disorder are ruled out without classical bipolar. The panel chose the narrow phenotype of classical bipolar, meaning grandiosity, elevated mood, decreased need for sleep, rapid cycling, flight of ideas, and hypersexuality and agreed to use the framework of frequency, intensity, number, and duration similar to the existing published guidelines on bipolar disorder to monitor symptoms. Monitoring the frequency of symptoms, the severity of symptoms, the quantity of symptoms, and the duration of symptoms in different domains would have to be considered prior to selecting an agent and prior to determining that a child had a disorder consistent with mania. An emphasis was made during this discussion that, as part of treatment, mood monitoring and the concept of measurement-based care would be critical in this population. Level I: Monotherapy could be attempted with either a mood stabilizer, like lithium, valproic, carbamazepine, olanzapine, quetiapine, risperidone, aripiprazole, or ziprasidone. The panel also agreed that, similar to the adult best practice guidelines, two antipsychotics should not be used or could not be supported in the treatment of bipolar symptoms in this age group. Level II: Monotherapy, up to two iterations of any of these agents listed above. Level III: Combination treatment. Two mood stabilizers could be used or a mood stabilizer and an atypical antipsychotic, but not two atypical antipsychotics. Level IV: Up to three agents, including agents like lamotrigine, a typical antipsychotic, or oxcarbazepine could be introduced as a third agent if previous treatments have failed. Level V: Clozapine and ECT were selected for the most complex and refractory cases. Clinicians should refer to the AACAP guidelines for ECT as noted above. The panel agreed that data for the treatment for bipolar disorder in children are scant. The panel used the existing data on bipolar guidelines to inform their discussion. Finally, psychotherapy approaches such as behavioral family therapy and social rhythm therapy warrant consideration in addition to medication options. Child & Adolescent    » ADHD    » Depression    » Bipolar Disorder    » Tourettes Syndrome    » Aggression Adults    » Schizophrenia    » Bipolar Disorder