Our search for an expert in bipolar disorder has brought us to you. Our teenager, at the age of 14, was referred to a clinical psychologist for treatment of depression. She attended weekly psychotherapy sessions for a period of 10 months. She then experienced a second episode of depression and was referred to a psychiatrist who prescribed antidepressants and lithium.

We then went to another psychiatrist for a second opinion. This one immediately discontinued the antidepressant and gradually stopped the lithium. A month later, our daughter experienced a psychotic episode. She was hospitalized for about 3 months and treated with risperdal and lithium. One week after discharge, the risperdal was discontinued. A week later she suffered another psychotic episode. Unfortunately, this time she was uncooperative and refused the medication. She was injected with Haldol and transferred to the psychiatric ward where other antipsychotic medications were given. After one week of hospitalization and daily injections, she worsened and was transferred to another hospital where all medications were discontinued. After a few days she was discharged and a week later risperdal and lithium were reintroduced.

It has now been 8 months since her release and she is still on the risperdal and lithium. She has been receiving various psychotherapies twice a week as an outpatient and goes to school 4 days a week, but complains of difficulty in concentrating.

Can you please verify the diagnosis and recommend treatment? Is there a chance of cure?

Unfortunately, this is an almost classic case history of adolescent patients diagnosed with bipolar disorder. The central issue of concern is to obtain a correct diagnosis - optimal treatment is completely dependent on this first step.

Whatever psychiatrist you choose to see your child should have experience and expertise in bipolar disorders in the child and adolescent population and should have available a comprehensive clinical history of the patient.

If we assume that the diagnosis of bipolar disorder is correct, then the fundamental treatment modality should be a mood stabilizer or thymoleptic such as lithium, valproate, etc. Then a secondary decision may be necessary as to the addition of an antidepressant and/or an antipsychotic agent. The specific choice of agent would depend on a variety of individual factors.