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The Future of Bipolar Disorder Management: Beyond the Clinic and Into the Community

The Future of Bipolar Disorder Management: Beyond the Clinic and Into the Community 1024 683 Abbie Miller
Teen sitting curled up on a couch, looking out a bright window, appearing thoughtful or pensive.

A new, state-of-the-field publication lays out tools and evidence for building community-based systems of care for youth with bipolar.

Individuals with bipolar disorders, a set of mental health conditions characterized by fluctuations in mood with periods of depression and mania, spend far more time dealing with the chronic burden of managing the disease than they do managing acute episodes. Because of this, the most effective care is that which is embedded in daily life, says Eric Youngstrom, PhD, director of the Institute for Mental and Behavioral Health at Nationwide Children’s. Dr. Youngstrom recently published a state-of-the-field review on bipolar assessment and treatment in Annual Reviews in Clinical Psychology.

Studio Portrait of Eric Youngstrom, PhD,

Eric Youngstrom, PhD

“For professionals, this community-based approach means shifting from a crisis response mindset to a long game strategy focused on early detection, lifestyle management and sustained maintenance,” he says. “To do this, we need to move care outside of the specialty clinics and hospitals and into the community – primary care, schools and family systems.”

To support this approach, the paper provides a structured framework for applying evidence-based assessment (EBA) and the 3 Ps: prediction, prescription and progress monitoring.

“Rather than viewing bipolar diagnosis as a static yes/no event, this paper encourages using a probabilistic model,” says Dr. Youngstrom. “We can use family history and screening scores as clues to shift the probability of a diagnosis, allowing for precise and personalized clinical decision making.”

Importantly, and supporting a nonbinary approach to diagnosis, Dr. Youngstrom emphasizes that bipolarity is a spectrum. Moving away from rigid categorical boxes and toward a dimensional model will drive the future of care to a more effective place, he says.

“We should be asking ‘how bipolar is this presentation’ rather than ‘if’ the presentation is bipolar,” he explains.

The median age of onset for bipolar disorder is 20 years, and the highest risk for first episode is around age 15, but it can affect teens and children of any age. Studies estimate that bipolar disorder in pediatric patients (under age 18 years) occurs in 1.8 to 3.9% of youth. To catch at-risk youth before their first manic or suicidal crisis, broad filters such as the Pediatric Symptom Checklist followed by more specific tools such as the CMRS10 empower clinicians to change the patient’s trajectory, according to the paper.

“When risk is moderate but the patient isn’t yet syndromal, we can prioritize interventions that are sensible, easy, cheap and safe (SECS),” says Dr. Youngstrom. “These include safe and logical things, such as making sure to get good and regular sleep, exercise (where you break a sweat!) or omega-3 supplementation.”

Additionally, Dr. Youngstrom urges clinicians to remember that functional recovery, growth and “successful adulting” are the goals.

“Treatment success should be measured by thriving — reclaiming school, work and relationships — not just the absence of symptoms,” says Dr. Youngstrom. “We can, and should, be preparing these young people to live functional lives in a community of support that they can take with them as they age out of pediatric care. Our work sets that stage.”

 

References:

  1. Youngstrom EA. Assessment and treatment of bipolar disorder in the community. Annual Reviews in Clinical Psychology. 2026;22:22.1-22.29. doi: 10.1146/annurev-clinpsy-061724-084055.
  2. Van Meter A, Moreira ALR, Youngstrom E. Updated meta-analysis of epidemiologic studies of pediatric bipolar disorder. Journal of Clinical Psychiatry. 2019;80(3): org/10.4088/JCP.18r12180
  3. Nierenberg AA, Agustini B, Köhler-Forsberg O, Cusin C, Katz D, Sylvia LG, Peters A, Berk M. Diagnosis and treatment of bipolar disorder: A review. 2023;330(14):1370-1380.
  4. McIntyre RS, Berk M, Brietzke E, Goldstein BI, López-Jaramillo C, Kessing LV, Malhi GS, Nierenberg AA, Rosenblat JD, Majeed A, Vieta E, Vinberg M, Young AH, Mansur RB. Bipolar disorders. Lancet. 2020 Dec 5;396(10265):1841-1856. doi: 10.1016/S0140-6736(20)31544-0.

 

Image Credit: Adobe Stock & Nationwide Children’s

 

About the author

Abbie (Roth) Miller, MS, MWC, is a passionate communicator of science. As the manager of medical and science content at Nationwide Children’s Hospital, she shares stories about innovative research and discovery with audiences ranging from parents to preeminent researchers and leaders. She is a Medical Writer Certified®, credentialed by the American Medical Writers Association, and received her masters of science in Health Communication from Boston University.

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