Okpaleke Amazu Chetanna, Nathwani Kashish, Berwerth Pereira Mariana, Rente Lavastida Dianella, Parker Jonathan M
Psychiatry, St. George's University School of Medicine, True Blue, GRD.
Psychiatry, American University of the Caribbean, Miramar, USA.
Cureus. 2024 Jul 10;16(7):e64271. doi: 10.7759/cureus.64271. eCollection 2024 Jul.
Bipolar disorder type 1 (BD-1) is a complex psychiatric disorder characterized by recurrent episodes of mania and depression. While manic episodes typically present with classic symptoms such as impulsivity, elevated mood, and increased energy, atypical presentations are not as common and when encountered may pose diagnostic challenges. In addition, multiple previous hospitalizations can prove for a more nuanced case with a potentially worse prognosis. This clinical case study explores the atypical clinical presentation of a 22-year-old Hispanic male with BD-1 and discusses the challenges associated with the correct diagnosis and recognition of this disorder. Typical BD-1 symptoms consist of depressive and manic episodes. The mania can encompass elevated mood, increased energy, racing thoughts, decreased need for sleep, grandiosity, and impulsivity. The typical depressive episodes consist of fatigue, low mood, loss of motivation, changes in appetite or weight, and even suicidal thoughts. Atypical symptoms consist of a mixture of both mania and depression at once, psychosis, present with seasonal patterns, anxious distress, catatonia, and rapid cycling of mood. The patient, with a medical history of BD-1, anxiety, polysubstance abuse, and multiple inpatient psychiatric hospitalizations presented to the emergency department via involuntary hold due to threats of suicidal behavior. Upon arrival, he presented with a myriad of typical and atypical acute manic symptoms including severe agitation, disorganization, anxiety, pressured speech, and rapid mood cycling. Throughout his admission he demonstrated extreme episodes of agitation, making threats of physical violence towards staff, attempting self-injury, behaving violently towards others, and displaying impulsivity as well as grandiosity despite receiving his long-acting injectable neuroleptic medication just three weeks prior to his hospitalization. Scheduled medication treatment during his inpatient hospitalization included a combination of risperidone, thorazine, divalproex sodium, mirtazapine, clonazepam, and temazepam. This clinical case underscores the importance of recognizing both typical and atypical presentations of manic episodes in BD-1 as well as the challenges involved in the treatment of a patient with severe and refractory symptoms requiring frequent hospitalizations.
1型双相情感障碍（BD-1）是一种复杂的精神疾病，其特征为躁狂和抑郁反复发作。虽然躁狂发作通常表现为冲动、情绪高涨和精力增加等典型症状，但非典型表现并不常见，一旦出现可能会带来诊断挑战。此外，既往多次住院治疗的情况可能表明病情更为复杂，预后可能更差。本临床病例研究探讨了一名患有BD-1的22岁西班牙裔男性的非典型临床表现，并讨论了正确诊断和识别该疾病所面临的挑战。典型的BD-1症状包括抑郁和躁狂发作。躁狂可包括情绪高涨、精力增加、思维奔逸、睡眠需求减少、夸大观念和冲动行为。典型的抑郁发作包括疲劳、情绪低落、动力丧失、食欲或体重变化，甚至自杀念头。非典型症状包括同时出现躁狂和抑郁的混合症状、精神病性症状、季节性发作模式、焦虑痛苦、紧张症以及快速的情绪循环。该患者有BD-1、焦虑症、多种物质滥用病史，且多次因自杀行为威胁而被非自愿送入急诊精神科住院治疗。入院时，他表现出一系列典型和非典型的急性躁狂症状，包括严重的激越、思维紊乱、焦虑、言语逼迫感和快速的情绪循环。在整个住院期间，他表现出极度的激越发作，对工作人员进行身体暴力威胁、试图自我伤害、对他人行为暴力，尽管在住院前三周刚接受了长效注射用抗精神病药物治疗，但仍表现出冲动和夸大观念。住院期间安排的药物治疗包括利培酮、氯丙嗪、丙戊酸钠、米氮平、氯硝西泮和替马西泮联合使用。本临床病例强调了识别BD-1中躁狂发作的典型和非典型表现的重要性，以及治疗有严重难治性症状且需要频繁住院的患者所面临的挑战。
