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. Author manuscript; available in PMC: 2010 Aug 4.
Published in final edited form as: Child Adolesc Psychiatr Clin N Am. 2009 Apr;18(2):353–ix. doi: 10.1016/j.chc.2008.12.002

Table 3.

Clinical interview red flags that should trigger thorough evaluation of possible PBD.

Red Flag Description Reason
Family history of BP* PBD most likely genetically driven 5x – 10x increase for 1st degree
relative; 2.5x-5x for 2nd degree
relative; 2x for “fuzzy” BP in
relative 47,49
Antidepressant Coincident Mania Manic symptoms while being treated
with antidepressants		 Undiagnosed PBD 38
Episodic Mood Lability Rapid switching between depressive
and manic symptoms; depressive and
manic symptoms at the same time		 Common presentation;
episodicity more suggestive of
mood diagnosis 7
Early Onset Depression Onset < 25 years First clinical episode is often
depression; substantial portion of
pediatric depressions ultimately
show bipolar course 28,148
Psychotic features True delusions/hallucinations in the
context of mood		 Delusions/Hallucinations
common during mood episode
40,149
Episodic Aggressive behavior Episodic; high-energy. Not
instrumental or planned; reactive		 Not specific, but common 7,40
*

This is the risk factor that is currently most amenable to incorporation in actuarial or Bayesian methods.