Pediatric emergency medicine trisk 4192 4192
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Children presenting with symptoms suggestive of mania need a thorough
medical evaluation to rule out any potential medical causes of their
symptoms including possible toxin exposure ( Table 126.1 ). Assess for
potential medical sequelae of impaired judgment, such as sexually
transmitted infections, need for emergency contraception, or occult head
trauma. Laboratory and imaging workup should be based on history and
clinical findings.
TABLE 126.22
ACUTE MANIA IN ADOLESCENCE: MOST COMMON
FEATURES
Pressured speech
Grandiosity
Apparent “high” (euphoria)
Rapid shifts of emotion
Euphoria
Anxiety/irritability
Combativeness/panic
Hypersexuality
The AACAP Bipolar Resource Center can be accessed at
/>Disorder_Resource_Center/Home.aspx .
Management
Psychiatric consultation is indicated if a new diagnosis of bipolar disorder is
suspected, a manic/mixed episode is present, or if the patient is engaging in
any unsafe behaviors. In younger children, outpatient management—with
the combination of mood-stabilizing medications and intensive behavioral
treatment—may be sufficient. Inpatient hospitalization is often required to
maintain the patient’s safety while effective treatments are being initiated.
Patients who are manic can have severely impaired insight and judgment.
This can lead to dangerous behaviors that can have lifelong consequences
