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Running head: BIPOLAR DISORDER TREATMENT PLAN

Bipolar Disorder Treatment Plan

Lukisha Harmon

Western Carolina University

RTH 352- Recreational Therapy Process and Techniques

Jennifer Hinton

April 29, 2016

BIPOLAR DISORDER TREATMENT PLAN 2

Case Study

Abstract:

This resident is a 15-year-old male diagnosed with multiple behavioral and mental illnesses that

include bipolar disorder, oppositional defiant disorder, attention deficit hyperactivity disorder

(ADHD), and substance abuse. Patient was referred to this inpatient psychiatric facility by a local

hospital and Office of Children’s Services. He was transferred to this unit on 07/10/2015.

Key Words:

Oppositional defiant disorder, ADHD, bipolar, polysubstance dependence, cognitive disorder

Purpose Statement:

The purpose of this case study is to understand the diagnoses and course of treatment of this 15-

year-old male and to examine the use of team sports, yoga, guided meditation, and teambuilding

as RT interventions to address patient and treatment team objectives.

Chief Complaint:

The resident was referred for a history of high risk behaviors, depression, elopement risk, and

suicidal ideation.

History of Present Illness:

This is a 15-year-old Native American from the northwest. He is in OCS custody. Apparently,

there is a history of parental substance abuse and neglect. The resident has been residing with his

grandmother since 04/01/2015, when he returned from residential treatment at a facility in

another state on 08/21/2014 and was allowed to live with his father; however, his father resumed

drinking and the resident was moved to his gradnmother’s house on 04/01/2015. She reports that

his behavior has been esculating since then. He himself started drinking several times a week,

often to the point of blacking out and also smoking marjijuana. When he saw his outspatient


provider, he expressed some suicidal ideation and became very agitated and was referred to the

regional hospital. The patient reports that he is not currently suicidal. He reports no auditory or

visual hallucinations and reports no delusions. The resident carries a diagnoses of bipolar

disorder, NOS. He does not currently exhibit any manic behaviors and does not report any

history of manic behaviors, however, it does not appear that in the past, he had a history of

extreme tantruming, aggression, and disruptive behaviors.

Past Psychiatric History:

The resident has a history of two inpatient admissions at this inpatient psychiatric hospital. He

was first admitted on 09/30/2013. He was discharged at the end of Novemeber 2013 and sent to

another facility for care. He was discharged on August 21, 2014 and followed up with an

outpatient behavioral health clinic. He was at a Boys and Girls Home from 03/22/2013 to

09/20/2013. He was transferred at that time to this facility for aggression. The resident was most

recently admitted to this facility on 04/29/2015. The resident carries diagnoses of ADHD; ODD;

bipolar disorder, NOS; cognitive disorder, NOS; history of polysubstance abuse; and rule out

FASD. Currently, the resident is on Abilify 15 mg daily at 2 p.m. In the past he has been on

Concerta 64 mg daily in the morning. He has also been on Prozac 10 mg twice daily and

Seroquel 200 mg daily in the morning and 300 mg daily at 5 p.m. Apparently, he was taken off

all the medication by his father when he returned from the residential facility. The resident has

no history of suicide attempts.

Family History:

His bioligical father and mother both have a history of alcohol dependence. No history of suicide

in the family is reported.

Medical History:


The resident reports no medical problems. No history of loss of consciousness or TBI’s.

Developmental History:

Exposure to alcohol in utero is suspected, but not documented. No history of perinatal trauma or

developmental delay. No history of enuresis or encopresis.

Substance Use History:

Please see HPI.

Social History:

The resident is currently in 9th grade. He reports that he is in normal classes, but receives mostly

D’s. He has a history of suspensions due to his behaviors, but no history of legal problems. Until

2013, he lives with his biological parents, at which time OCS took custody. After sometime in

residential and acute inpatient treatment, he was returned to his father’s custody, but then

removed again in the Spring of 2015 because his father was abusing alcohol.

Review of Symptoms:

The resident denies general, GI, GU, cardiovascular, respiratory, or neurologic complaints.

Vital Signs:

Blood pressure 132/77, pulse 69, and temperature 97.9.

Allergies:

No Known Drug Allergies (NKDA)

Mental Status Exam:

General Apperance: This is a 15-year-old male who appears his stated age. Neatly

dressed and groomed. Cooperative with the interview. Eye contact is fair.

Speech: Impoverished

Psychomotor Activity: Within normal limts.


Affect/Mood: Mood reported as okay. Affect is restricted.

Thought Process: Concrete

Thought Content: Reality-based. Denies auditory and visual hallucinations. Currently

denies thoughts or suicide, self-harm, or harm to others.

Orientation: He was oriented to person, place, time, and situation.

Memory: Able to answer 4/4 general knowledge questions. Able to remember 3/3 words

after 5 minutes. Was able to do serial 3’s but not serial 7’s. When asked what he will do

if he found somebody’s wallet in the store, he reports that he would take the money.

When asked if he has three wishes, the resident states that he would like to go home and

has no other wishes. He reports that he doesn not know what he wants to be when he

grows up.

Estimation of Intelligence: Below average.

Judgment and Insight: Assessed to be poor.

Assessment:

This resident requires residential treatment for ongoing treatment of high risk behaviors and

depression.

Assets:

This is a 15-year-old male who enjoys good health. He likes basketball and has a positive

attitude towards treatment.

Liabilities:

Include a family history of substance abuse, personal history of substance abuse, possible

exposure to alcohol in utero, cognitive impairment, history or poor judgment, and a history of

witnessing domestic violence and neglect. He also has a history of suicidal ideation.


Provisional Diagnoses:

Axis I: Attention deficit hyperactivity disorder

Oppositional defiant disorder

Bipolar disorder, not otherwise specified

Cognitive disorder, not otherwise specified

History of polysubstance dependence

Axis II: No diagnosis

Axis III: Rule out fetal alcohol spectrum disorder

Psychiatric/Medical Psychosocial Stressors

Axis IV: Severe

Axis V: GAF- 40

Initial Treatment Plan of Care:

The resident has been admitted to residential treatment. History and physical be provided. The

clinical therapist performed the psychosocial evaluation and coordinate individual, group, and

family interventions. The resident will be evaluated on a routine basis by the attending

psychiatrist who will coordinate with the interdisciplinary treatment plan.

Estimated Length of Stay:

300 days.

Initial Discharge Plan:

Upon indication that the resident can be manages at a lower level of care in the community; he

will be evaluated for discharge.

Total time spent 45 minutes; greater 50% of this time was spent providing counseling and

coordination of care.


Recreational Therapy

Resident Assessments

On July 14, 2015, the recreational therapy intern conducted the three assessments that are

required by the facility. The assessments are expected to be done within the first 7 days of the

resident admitting to the program. This resident had been in this program for 5 days when the

assessments were conducted. The evaluation was done in a conference room away from the other

adolescent residents.

The first assessment was the Recreational Therapy Assessment that was built by the

recreational therapy supervisor. The items revolve around these therapeutic areas:

decision making/problem solving, communication/socialization,

coping/frustration/resiliency, and attention/memory/orientation. The first part of the

assessment is a Likert scale and the second are narrative questions. The results of this

assessment are recorded by an RS narrative summary that delineates the residents affect,

participation in the interview, and behaviors observed by the RS. This resident’s

summary is the following:

‘Resident presented an insightful affect when answering items. He sat quietly and calmly

throughout the assessment. He answered low scores for items that questioned self-

confidence. He relayed to RS that he would like to learn how to deal with “stress”.’

The second assessment that was conducted was the Resiliency Attitudes and Skills

Profile (RASP). This measures and has subscores for creativity, humor, independence,

initiative, insight, relationships, and values orientation. The residents scored particularly

low for his subscores of creativity, independence, and insight.


The third assessment that the recreational therapy program requires is the Comprehensive

Evaluation in Recreational Therapy- Psych Revised (CERT-PR). The recreational

therapist is supposed to write up this evaluation based on observations of the resident.

There are three categories (General, Individual, and Group Interaction) that are scored

separately then an overall score. The results showed that his individual and group

interaction were ‘problematic’ and needed improvement.

Due to the nature of this program, the intern would not be working at the facility when that

resident would be discharged. To show results of some sort, two extra assessments were

conducted on July 7, 2015. From three assessments already taken, it was determined that the

residents’ goal should be to increase self-worth. The two assessments conducted were the Social

Empowerment and Trust scale (SET) and the Rosenberg Self Esteem scale.

The SET scale revealed that this resident has a problem with bonding/cohesion,

empowerment, and awareness of others. His total score was an 85.

The Rosenberg scale resulted in a 22, which is about average for this scale.

During both of these assessments, the resident presented a disinterested affect and a lack of

insight. For a lot of his answers, his behaviors and actions towards his treatment did not match.


Bipolar Disorder

Definition

Bipolar disorder is a brain disorder that is marked by periods of elation and

depression. This disorder of the brain causes unusual shifts in mood, energy, and activity levels.

Children with this disorder tend to have intense emotional states that occur in distinct periods

called mood episodes. Each episode represents a huge change from the individual’s normal mood

and behavior (National Institute of Mental Health, 2012). Bipolar disorder makes it extremely

difficult for the individual to carry out day-to-day tasks. These tasks may include things like

hanging out with friends or going to school. The symptoms of this disorder can sometimes be

very severe. The ups and downs that are experienced are very different than the normal ups and

downs that someone would experience every once in a while. The symptoms can lead to

damaged relationships, poor school performance, and sometimes suicide (National Institute of

Mental Health, 2012).

There is currently no known cure for bipolar disorder. However, there is treatment

for this disorder that allows the individual to have a full and productive life. The symptoms of

bipolar disorder tend to develop in the late teen years and early adulthood, although some

individuals do begin to display symptoms during childhood. Children are six times more likely to

develop the illness if a parent or sibling has it, because bipolar disorder tends to run in families

due to a genetic component (National Institute of Mental Health, 2012).

According to the DSM-5, there are four primary diagnoses for bipolar disorder.

These diagnoses include: bipolar I disorder, bipolar II disorder, bipolar disorder not otherwise

specified (BP-NOS), and cyclothymic disorder (American Psychiatric Association, 2013).

According to the National Institute of Mental Health, bipolar I disorder is characterized by manic


or mixed episodes. These episodes must persist for at least seven days. Manic symptoms may

occur that are very severe and they could possibly lead to hospitalization of the individual.

Usually depressive episodes occur that last at least two weeks. In addition, bipolar II disorder is

characterized by depressive episodes and hypomania episodes that occur in a pattern. Individuals

do not experience full-blown or mixed episodes. Bipolar disorder not otherwise specified (BP-

NOS) is characterized by symptoms of the illness that do not meet the diagnostic criteria for

bipolar disorder I or bipolar disorder II. The symptoms that are shown are out of the individuals

normal behavior range, as stated by the National Institute of Mental Health. Lastly, cyclothymic

disorder is a mild form of bipolar disorder. It is characterized by episodes of hypomania and mild

depression. These symptoms last for at least two years. These symptoms do not meet the criteria

for any other type of bipolar disorder (National Institute of Mental Health, 2012).

Demographic Information

Overall, bipolar disorder affects 2 percent of the world population (DynaMed Plus,

2015). The National Comorbidity study reported a lifetime prevalence of nearly 4 percent for

bipolar disorder (Centers for Disease Control and Prevention, 2013). Bipolar disorder is less

common in men than in women. The ratio is approximately two men to every three women.

The onset age of bipolar disorder tends to occur at a younger age for men. According

to the Center for Disease Control and Prevention, the median onset age is typically twenty-five

years of age (2013). According to Kathleen Merikangas and the National Institute of Mental

Health, about 3.9 percent of adults meet criteria for bipolar disorder in their lifetime. 2.5 percent

of children meet the criteria in their lifetime. The rates of bipolar disorder increase with age. 2.1


percent of younger teens reported symptoms, while 3.1 percent of older teens reported symptoms

of bipolar disorder (National Institute of Mental Health, 2012).

Strengths of Client

My client’s strengths are evident in his attitudes towards treatment. It appears to me

that he is ready for treatment. My client also really enjoys being in good health, which makes his

attitude towards treatment more positive. I believe that this positive attitude will be very

beneficial during his treatment. He is also taking traditional classes at school. I see this as

strength because he is still able to be around his peers and people his age. This gives him the

opportunity to be social and increase his social skills. He is developmentally able to be in these

classes, we just need to address the issues that are holding him back from doing his best. This

type of structure could potentially be very beneficial for my client.

Needs of Client

My client needs more individualized help in the school setting. He is having trouble

keeping up with classes and maintaining his grades. He needs to have a very structured

setting with other accommodations to ensure that he is doing his best. Bipolar disorder

makes it hard for students to function. It is extremely hard for them to stay focused

(Samuel, 2006.) I think that it would be beneficial to teach my client skills that he could

use to help cope with his symptoms while he is in school.

My client has a history of high risk behaviors. He needs assistance managing his

behaviors before he experiences and engages in those types of behaviors again.

According to the National Institute of Mental Health, people with bipolar disorder tend to

engage in extremely high risk behaviors that can lead to more serious issues (2012). This


can also be due to the fact that my client is also diagnosed with ADHD. Bipolar disorder

and ADHD tend to co-occur (Carlson, 2012).

Environmental Barriers

Being in OCS custody is a barrier for my client. He is not with anyone that he knows and

is close with. My client does not really have a steady support system, as mentioned

earlier. Having a good support system could be very helpful for him in treatment. Results

from a study show that people in family therapy respond better to treatment (National

Institute of Mental Health, 2008).

My client has witnessed domestic violence and neglect in his life. This can affect the way

that he perceives things. He might think that his behaviors are okay because he has

witnessed them before. This increases the likelihood that he would engage in these

behaviors. Studies show that people who witness or experience violent events are more

likely to act violently (American Journal of Public Health, 2002).

Cultural Information

My client is fifteen years old. Most individuals do not show signs and symptoms of

bipolar disorder until their late teenage years or early adult years (National Institute of

Mental Health, 2012). However, according to the National Institute of Mental Health,

some children can begin to show signs and symptoms as well (2012).

My client is a male. Bipolar disorder tends to be less common in men than in women

(Centers for Disease Control and Prevention, 2013). According to the National Institute

of Mental Health, the median the ratio of bipolar disorder is two men to every three


women (2012). So, for every three women diagnosed there are two men that are also

diagnosed.

My client is Native American and is from the northwest.

It is suspected that my client was exposed to alcohol in utero.

My client’s intelligence level is considered below average.

Efficacy Research

Moxham, L., Liersch-Sumskis, S., Taylor, E., Patterson, C., & Brighton, R. (2015). Preliminary

outcomes of a pilot therapeutic recreation camp for people with a mental illness: Links to

recovery. Therapeutic Recreation Journal, 49(1), pages 61-75.

1. Summary

This study was conducted to understand the effects of therapeutic recreation on

recovery in people with mental illness who attend camp. The researchers wanted to know

the benefits that therapeutic recreation could have on individuals with mental illnesses.

They thought that a good way to get people with mental illnesses engaged in physical

activity would be to give them therapeutic recreation opportunities. They had the

opportunity to get out of their comfort zones by participating in physically and mentally

challenging activities. They planned for a group of individuals with different mental

illnesses to attend a five-day camp. They planned to evaluate the outcomes of the

program to see if therapeutic recreation was effective for people with mental illnesses.

The researchers wanted to explore the experiences of a cohort of people with mental

illnesses through a completely voluntary recreation recovery camp. They conducted the

study on 27 adults between the ages of 21 and 71. The results indicated that the camp was


successful because the participants perceive that the majority of their expectations were

met.

2. Subjects and Methods

The participants of this camp included 27 adult males and females. They were

between the ages of 21 and 71. They had a variety of mental illnesses that included:

PTSD, schizophrenia, bipolar disorder, anxiety, major depression, addiction, eating

disorders, and personality disorders. A lot of the participants also had some comorbid

physical health issues. These include sleep apnea, diabetes, irritable bowel syndrome,

asthma, chronic fatigue, hypothyroid, back pain, poor mobility, hypertension, and many

more. The camp focused on each participant’s strengths using a person-centered

philosophy.

This was a five-day overnight camp in through the YMCA in Australia. The

participants resided in shared cabins for the week. They also had unique staff that

consisted of mental health nurses, health students pursuing a nursing or psychology

degree, and therapeutic recreation leaders .The camp provided physically and mentally

challenging experiences and activities to the participants. They had to the opportunity to

engage with high ropes, rock climbing, giant swings, flying fox, and tai chi. The tai chi

program was included to help the participants with balance. There were also education

classes that were included in this camp. They informed the participants about the

importance of exercise, physical well-being, and an appropriate diet. Arts and crafts

sessions addressed relaxation and creativity.

At the beginning of this five-day overnight camp, the participants were given a

sheet of paper, which they folded in half. On one side they wrote down their expectations


for the week. They indicated what they wanted to gain from this recovery camp. The

other side was to be completed at the end of camp. At the end of the week they would

rate how well their expectations were met. Based on a 10- point Likert scale, 10

represented completely met and 1 represented not met. At the conclusion of camp they

gathered all of the data collected from the participants, and combined it all together to get

their collective results.

3. Findings and Implications

The overall analysis of this study showed whether the participant’s expectations

were met. The results indicated that therapeutic recreation does benefit people with

mental illnesses. It changed the way that the participants perceived their recovery. There

were a lot of themes that were central throughout the participant’s expectations. They

were identified as meeting new people and getting out of their comfort zones. A majority

of the participants had all of their expectations met. The study indicated that 16.94 % of

expectations were met, 25.63 % were strongly met, and 51.63 % completely met. It also

concluded that only 5.63 % of the participant’s expectations were not met or strongly not

met. Areas that were marked as not met were typically areas of physical well-being.

However, there were a few areas of camp that all participants were able to participate in.

Some of the activities had a weight limit and some participants cold not participate in that

activity since they exceeded the weight limit. These participants did not get the full

experience of this recovery camp, but they still reported that their expectations were met.

The knowledge that was gained from this study acknowledges the different

aspects of well- being that are very important for recovery. These aspects include

communication, forming relationships, and challenging yourself. The results of this study


can be used to inform about treatment of many different mental illnesses. The participants

reported that as a result of camp they feel that their confidence has increased, they have

grown in their social connections, and their personal responsibilities have been enhanced.

Overall, this study was very effective and the hypothesis that therapeutic recreation can

contribute to recovery was proven.

4. Applications for this Case

This study can be very helpful in planning an intervention for my client. My client

has a diagnosis of bipolar disorder and I believe that a camp like this would be great for him,

because the camp included people with bipolar disorder and they indicated that their

expectations were met. This camp helps people with mental illnesses overcome obstacles and

become more independent through the use of therapeutic recreation. A lot of these

participants had comorbid diagnoses like my client. This camp addressed majority of their

needs and helped them become independent in a lot of those areas by the end of the week.

My client has difficulties maintaining relationships, and I believe that being in this

environment with other people his age for a week could be beneficial for him. I think the use

of different recreational activities could be potentially helpful in my client’s recovery. A lot

of clients reported that they were more relaxed, less stressed, could communicate better, had

increased confidence, could connect socially, and could form relationships. These are all

areas that my client could use work in, but specifically communication and forming

relationships.

This study was conducted on adults, but I would make a few modifications so that it

can better meet the needs of my client. The camp would be for children and adolescents

instead of adults. I would also include more games and activities that would be more


intriguing to that specific age range. Instead of teaching tai chi for balance, we could teach

mindfulness and appropriate coping skills. These would be things that could help these

children cope with the symptoms of their mental illness.

Phase 3

Top three strengths:

My Cl. enjoys being in good health.

My Cl. is intrinsically motivated

My Cl. has a positive attitude towards treatment.

Top three needs:

My Cl. needs individualized help in the school setting.

My Cl. needs help managing his behaviors and making appropriate decisions.

My Cl. needs to improve his social skills

Goal list:

Increase decision making skills

Increase social skills

Decrease impulsive/risky behaviors

Facility:

The Cl. is in an inpatient residential treatment facility. He was referred to this facility by

a local hospital and children services. They estimated that he would be there for about

300 days.

Intervention:


The intervention that will be used for this Cl. is to attend a therapeutic recreation camp c

other children and adolescents from the treatment facility. He will attend a five-day overnight

camp. The Cl. will participate in different activities throughout the week. These activities

include; high ropes courses, rock climbing, giant swings, problem solving games, and team

building exercises. The Cl. is expected to attempt all activities, but fully participate in at least

3 /d with the supervision of the CTRS and other staff. These activities will help the Cl. c his

social skills, decision-making, and confidence.

Behavioral Objective #1 (skills practice/acquisition):

During the camp activities in the first day, cl. will wait to engage in activities, until given

instruction in 3 of the 6 activities, with no more than 3 prompts from the CTRS per

activity, to demonstrate the ability to choose against impulsive behavior.

Behavioral Objective #2 (functional use):

During the activities in the last 4 days of camp, cl. will wait to engage in 5 of the 6

activities /d with no more than 1 prompt from CTRS /d, to demonstrate the ability to

independently choose to not engage in impulsive behavior.

S.O.A.P Note

S-Subjective:

The cl. asked why he has to wait for instructions if he already knows how to do an

activity. He stated, “ I do not like waiting because most of the time I already know hat

I’m doing.” The cl. told the CTRS that he did not see the point in what they were making

him do. He stated that it “takes up too much time.”

O-Objective:


During the activities the cl. would roll his eyes, or huff and puff. He would mumble

under his breath every time he was given a prompt to wait for instructions. The cl. would

scream loudly when he was given multiple prompts in a short period of time. However,

he followed every prompt that he was given.

A-Analysis:

The cl. appeared to be very annoyed and frustrated during the first day of camp. He did

not exceed the maximum number of prompts in the first day. He seemed to be agitated,

but he successfully followed the prompts given by the CTRS. Eventually, he was able to

complete an activity with only 1 prompt in the first day. By the second day the cl. was

able to wait for instructions with 3 or less prompts per day. He did not meet the objective,

but he did show improvements.

P-Plan:

The cl. accomplished the objective in the skill practice/acquisition stage, however he did

not meet the goal in the functional use stage. He was very close to meeting this goal. I

think I could take a little away from this objective to see how he does with that, and add

more form there. I think the cl. would benefit from another camp similar to this one.

However, he would mainly working in the functional use stage. For now, cl. will continue

to work on the interventions in the skill practice/acquisition stage e.m.p in everyday

situations at his inpatient facility, until he is able to attend camp again.

Discharge Summary:

1. The cl. is a 15 y/o male. His primary dx is bipolar disorder. Cl. has difficulties with

social skills, decision-making, and impulsivity/risky behavior. The client attended a

five-day, weeklong camp. His goals were to decrease impulsive/risky behavior.


2. Cl. was a part of a weeklong therapeutic recreation camp. For the first day he engaged

in 6 interventions to help him c impulsivity where he received a maximum of 3

prompts from the CTRS. On the last for days, the cl. was aiming to engage in 6

interventions c no more than 1 prompt per activity. The cl. met the first objective, and

is still working towards the second.

3. The cl. practiced the skill for the first day of camp. He did exceptionally well. He was

able to engage in the interventions with no more than 3 prompts. Later during the

week, cl. was able to engage in the interventions, but he needed more prompts than

originally determined.

4. I am concerned that the client still needs to work on his impulsivity. He has made

tremendous progress at the therapeutic recreation camp, however he could use a little

more practice in the the skill acquisition stage before moving to the functional use

stage. At camp we were not able to address the client decision-making skills and

social skills. I believe that this is something that he can continue to work on with the

CTRS.

5. The cl. Will continue to work with the CTRS once he is discharged from this

inpatient facility. He and the CTRS will continue to work on his impulsivity, as well

as his decision- making and social skills. Once the cl. is discharged I will refer him to

an outpatient facility where he will continue to work with the CTRS. While working

with the CTRS, he will also also attend a group with people around his age to work

on his social skills.

Signature of CTRS:


Lukisha L. Harmon, RT Student_______________________, April 29, 2016

Signature of Client:

Signature of Client Guardian:


References

American Psychiatric Association. (2013). Bipolar and related disorders. In Diagnostic and

Statistical Manual of Mental Disorders: DSM-5. Washington, D.C: American Psychiatric

Publishing.

doi:

10.1176/appi.books.9780890425596

Carlson, G. A. (2012). Differential diagnosis of bipolar disorder in children and

adolescents. World Psychiatry, 11(3), 146–152.

DynaMed Plus. (2015, September 22). Bipolar Disorder. EBSCO Information Services.

Moxham, L., Liersch-Sumskis, S., Taylor, E., Patterson, C., & Brighton, R. (2015). Preliminary

outcomes of a pilot therapeutic recreation camp for people with a mental illness: Links to

recovery. Therapeutic Recreation Journal, 49(1), pages 61-75.

National Institute of Mental Health. (2012).Bipolar disorder in children and adolescents.

Retrieved January 2016 from

http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-

adolescents/index.shtml


National Institute of Mental Health. (2012).Rate of bipolar symptoms among teens approaches

that of adults. Retrieved January 2016 from http://www.nimh.nih.gov/news/science-

news/2012/rate-of-bipolar-symptoms-among-teens-approaches-that-of-adults.shtml

National Institute of Mental Health. (2008). Family-focused therapy effective in treating

depressive episodes of bipolar youth. Retrieved January 2016 from

http://www.nimh.nih.gov/news/science-news/2008/family-focused-therapy-effective-in-

treating-depressive-episodes-of-bipolar-youth.shtml

Samuel, V. J. (2006). Bipolar disorder in schools [Fact Sheet]. CA: Positive Environments,

Networks, of Trainers.

Swanson, J. W., Swartz, M. S., Essock, S. M., Osher, F. C., Wagner, H. R., Goodman, L. A., and

Meador, K. G. (2002). The social-environmental context of violent behavior in persons

treated for severe mental illness. American Journal of Public Health, 92(9), 1523-1531.

doi: 10.2105/AJPH.92.9.1523

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