Omega-3 Fatty Acid Adjunctive to Open-Label Aripiprazole for the Treatment of Bipolar Disorder in Children and Adolescents

Inclusion Criteria: 1. Male or female subject, 6-17 years of age 2. Subject has a DSM-IV diagnosis of bipolar I, bipolar II, or bipolar spectrum disorder and currently displaying manic, hypomanic, or mixed symptoms (with or without psychotic features) 3. Subject and their legal representative have a level of understanding sufficient to communicate intelligently with the investigator and study coordinator, and to cooperate with all tests and examinations required by the protocol 4. Subject and their legal representative must be considered reliable 5. Subject and his/her authorized legal representative must understand the nature of the study. The subject's authorized legal representative must sign an informed consent document and the subject must sign an informed assent document 6. Subject must have an initial score on the Young-Mania Rating Scale (Y-MRS) of at least 20 7. Subject must be able to participate in mandatory blood draws 8. Subject must be able to swallow pills 9. Subjects with comorbid Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Obsessive Compulsive Disorder (OCD), Pervasive Developmental Disorders (PDD), anxiety and depressive disorders will be allowed to participate in the study provided they do not meet for any of exclusionary criteria 10. For concomitant therapy used to treat ADHD, subject must have been on a stable dose of the medication for 1 month prior to study enrollment. The dose of the ADHD therapy may not change throughout the duration of the study. Exclusion Criteria: 1. Investigator and his/her immediate family; defined as the investigator's spouse, parent, child, grandparent, or grandchild 2. Serious, unstable illness including heptic, renal, gastroenterological, respiratory, cardiovascular (including ischemic heart disease), endocrinologic, neurologic, immunologic, or hematologic disease 3. Uncorrected hypothyroidism or hyperthyroidism 4. History of sensitivity to omega-3 fatty acids. A non-responder or history of intolerance to omega-3 fatty acid, after treatment at adequate doses as determined by the clinician. 5. Severe allergies or multiple adverse drug reactions. 6. Non-febrile seizures without a clear and resolved etiology 7. DSM-IV substance (except nicotine or caffeine) dependence within past 6 months 8. Judged clinically to be at serious suicidal risk 9. Any other concomitant medication with primarily central nervous system activity other than specified in the Concomitant Medication portion of the protocol. 10. Current diagnosis of schizophrenia 11. Pregnant or nursing females