The COVID-19 pandemic has stressed the entire nation, and it is well-know that stress is a contributor to worsening mental health, especially for those already coping with mental health challenges. During the COVID-19 pandemic it’s important to look at how public health interventions to lessen illness and loss of life may affect patients struggling with bipolar disorder. One change that often follows treatment disruption is that patients return to their pediatric primary care provider to rebuild the care team and create an effective treatment plan. The following is a case example:

Suzie is a 17 year old high school senior with Bipolar Disorder. She has endured several episodes of depression and two of mania already. Suzie was stable on a combination of an atypical antipsychotic and Lithium, and looked forward to graduation and college entry. Following the Coronavirus lockdown, Suzie was not happy about online schooling. She missed her friends, and had trouble accepting the disappointment of missing out on the special rights of passage of her senior year. An on again off again relationship with a boyfriend added to her emotional stress. Her parents noticed that she was more oppositional and challenging at home. This was not beyond expectable for a house-bound teenager. Suzie had smoked marijuana in the past. She was adamant when her mother questioned her that she had not resumed smoking. Additionally following a mix up with her mail order pharmacy plan, Suzie missed several doses of her medication. Quite suddenly she began displaying symptoms such as sleeplessness, irritability, agitation, grandiosity, and Suzie was talking nonstop.

Mother could not reach her psychiatrist because of the Coronavirus crisis. She reached out to Suzie’s pediatric primary care provider (PCP) who in turn called Project TEACH for a phone consultation with a Project TEACH Child and Adolescent Psychiatrist. The PCP readily recognized the rapid development of a manic symptom picture, and wanted to get the best guidance on what medication regimen to resume and/or initiate in order to address Suzie’s manic symptoms. Additionally the PCP obtained a Lithium level showing it to be low as a result of the missed medication doses. On advice from Project TEACH, Suzie’s prescribed regimen was restarted, and quickly took care of her manic symptoms. The PCP was also advised by the consulting Project TEACH Child and Adolescent Psychiatrist to use Clonazepam at night to help promote adequate sleep and calm quickly. The PCP and mother were also able to have her therapist temporarily increase virtual visits to stabilize Suzie’s behavior during the Coronavirus pandemic.

This case illustrates how an otherwise stable teenaged girl with Bipolar Disorder became acutely ill secondary to several environmental stressors. Also illustrated is the importance of sustained medication adherence. Most of all the quick action of her PCP with consultation from Project TEACH, enabled rapid re-stabilization and averted a possible hospitalization.

Pediatric Primary Care Providers in New York State have long enjoyed free access to phone consultation, referral for services, and one-time psychiatric assessments available through Project TEACH. Flexible, creative, collaborative approaches like telemedicine and psychiatric phone consultation to primary care providers are lifesavers for specific vulnerable groups during unusual adverse conditions such as during a pandemic. They also offer lessons to help us provide more effective modes of service when the pandemic eventually ends.