A 12-year-old boy with no psychiatric history and no evidence of substance use presents with his first manic episode. Throughout the past 4 weeks, his family, school, and friends have noted distinct changes in his mood and behavior. His mood has oscillated between euphoria and severe irritability, with little or no provocation. He has been awake…

This paper presents a case of an 11-year-old boy who was admitted to an acute inpatient psychiatric setting because of a recent exacerbation of physical aggression, accompanied by long-standing problems with verbal aggression, irritability, dysphoria, and sleep disturbance. His family history was notable for domestic violence, substance abuse by…