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Secondary carnitine deficiency (SCD) is triggered by excessive carnitine loss, a couple of metabolic disorders, poor carnitine content in the diet or malabsorption, Fanconi syndrome (free carnitine loss through renal tubule), peritoneal dialysis or elevated excretion of acyl-carnitine (Winter SC, 2003)

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Custodial grandparents complete The Pittsburgh Sleep Quality Index (PSQI), a self-assessment of perceived sleep quality [20] online via Qualtrics

These findings represent a distinct period of abnormally elevated mood and energy accompanied by psychotic symptoms, which is highly characteristic of Bipolar disorder, manic, with psychotic features