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 https://www.aacap.org/aacap/families_and_youth/resource_centers/Bipolar_ 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