Bipolar Disorder NOS

Jamie is a 12-year-old student at your local school who has had behavior problems for 3 years. He has currently been diagnosed with Bipolar Disorder Not Otherwise Specified (Bipolar Disorder NOS). He was diagnosed after experiencing highly irritable mood for 8 days last month which was a marked change from his “normal” mood. He also had a depressive episode in 2010 which at the time was diagnosed as Major Depressive Disorder, Single Episode. Lately his mood was accompanied by increased physical restlessness and decreased need for sleep. The latest diagnosis was done by his physician who is an MD but not a psychiatrist. She used the ICD-10 criteria for making the diagnosis. You have a release to speak with her and she says she believes Jamie’s symptoms are “subthreshold” but illustrate Bipolar Spectrum Disorder. She has Jamie on a combination of Divalproex, Clonidine and Zoloft. 1) Assuming you are responsible for coordinating care, where would you start with this client and his family and what are the top two things you feel should be done? 2) The parents asked you what the “black box” warning on Clonidine meant – how would you answer them? 3) Jamie’s parents want to know what they can do at home? Where would you start with them?