Effects of season and climate on the first manic episode of bipolar affective disorder in Korea

OBJECTIVE: To report a case in which bipolar depression was resistant to usual therapies, requiring dosages of bupropion >450 mg/d and to review the literature on mania associated with bupropion and propose a potential theory of a dose-related threshold associated with bupropion and mania. CASE SUMMARY: A 44-year-old white man with a 25-year history of bipolar affective disorder presented with depression resistant to usual therapies. Bupropion therapy was initiated and the dosage was titrated to 600 mg/d. After exceeding the maximum recommended daily dose (450 mg/d), he experienced a manic episode attrib uted to high-dose bupropion. DISCUSSION: Due to increased risk of seizures, current prescribing guidelines state that the total daily dose of bupropion is not to exceed 450 mg/d. Since bupropion is the agent least likely to cause a manic switch in bipolar disorder, this agent seemed a logical choice to treat the patient's depression. Due to a lack of response, the bupropion dosage was titrated to a maximum of 600 mg/d. Since the patient did not switch into mania until the dosage exceeded 450 mg/d, we speculate that this adverse reaction is a dose-related phenomenon. Scientific literature supports this theory. CONCLUSIONS: A switch into mania is a potential risk associated with antidepressant drug use in bipolar affective disorder. Bupropion is believed to be associated with a decreased risk compared with other antidepressant therapies. However, our case report as well as others support the theory that this decreased risk may be due to dosages not exceeding the recommended daily dose (450 mg/d). Doses of bupropion >450 mg/d should be used with caution in depressed patients with bipolar affective disorder.

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Lithium use in a patient on haemodialysis with bipolar affective disorder and lithium-induced nephropathy

BMJ Case Reports ◽

10.1136/bcr-2021-242841 ◽

2021 ◽

Vol 14 (7) ◽

pp. e242841

Author(s):

Sam Topp ◽

Emma Salisbury

Keyword(s):

Affective Disorder ◽

Bipolar Affective Disorder ◽

Manic Episode ◽

Dose Titration ◽

Dialysis Session ◽

Treatment Resistant ◽

History Of ◽

End Stage ◽

Level Monitoring

Lithium is an effective mood stabiliser used to treat bipolar affective disorder (BPAD); however, it can also adversely affect the kidneys, causing acute toxic effects, nephrogenic diabetes insipidus, chronic renal dysfunction and end-stage kidney disease (ESKD) in a minority of patients. We describe the case of a man with a 34-year history of BPAD type-1 and a 2-year history of ESKD secondary to lithium-induced nephropathy who experienced a manic relapse. He previously responded well to lithium but, following a deterioration in kidney function, was switched to olanzapine and sodium valproate. This precipitated a period of instability, which culminated in a treatment-resistant manic episode requiring hospital admission. After a multidisciplinary team discussion, lithium therapy was restarted and provided remission. This was achieved safely through a reduced dosing schedule of three times a week post dialysis, slow dose titration and blood level monitoring prior to each dialysis session.

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Neurocysticercosis presenting as bipolar disorder: a case report

General Psychiatry ◽

10.1136/gpsych-2021-100663 ◽

2021 ◽

Vol 34 (6) ◽

pp. e100663

Author(s):

Surbhi Batra ◽

Sumit Kumar ◽

Lokesh Singh Shekhawat

Keyword(s):

Bipolar Disorder ◽

Case Report ◽

Depressive Symptoms ◽

Affective Disorder ◽

Postpartum Period ◽

Bipolar Affective Disorder ◽

Taenia Solium ◽

Manic Episode ◽

Symptoms And Signs ◽

Rule Out

Neurocysticercosis is the most common neuro-parasitosis caused by the larval stage of Taenia solium. The most common manifestations include seizures and hydrocephalus. Psychiatric abnormalities are relatively rare but depressive symptoms are frequent in patients with neurocysticercosis. However, mania as a presentation is relatively rare. Pregnancy and the postpartum period are relatively vulnerable times and they can lead to reactivation of existing neurocysterci lesions. We are discussing the case of a 23-year-old female patient with neurocysticercosis leading to the reactivation of lesions in the peripartum and postpartum period leading to bipolar affective disorder. Improvement in the patient was seen with a combination of antipsychotics, antihelmintics, antiepileptics and steroids, along with improved radiological signs of neurocysterci lesions. Although neurocysticercosis is a common illness, its prevalence presenting as a manic episode is merely 2.6% and, hence, missed easily. Therefore, it is important to rule out organic aetiology in patients even with a classic presentation of bipolar affective disorder and those having any other neurological symptoms and signs.

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Bipolar illness

Oxford Handbook of Psychiatry ◽

10.1093/med/9780199693887.003.0008 ◽

2013 ◽

pp. 301-350

Keyword(s):

Affective Disorder ◽

Historical Perspective ◽

Bipolar Affective Disorder ◽

Manic Episode ◽

Spectrum Disorder ◽

Bipolar Illness ◽

Clinical Notes ◽

Bipolar Spectrum Disorder ◽

Hypomanic Episode ◽

Depressive Episodes

Introduction Historical perspective Mania/manic episode Hypomania/hypomanic episode Bipolar spectrum disorder Bipolar (affective) disorder 1: classification Bipolar (affective) disorder 2: clinical notes Bipolar (affective) disorder 3: aetiology Bipolar (affective) disorder 4: management principles Other issues affecting management decisions Treatment of acute manic episodes Treatment of depressive episodes...

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A Retrospective Case-Note Study of Bipolar Disorder in Old Age

The British Journal of Psychiatry ◽

10.1192/bjp.158.4.485 ◽

1991 ◽

Vol 158 (4) ◽

pp. 485-490 ◽

Cited By ~ 45

Author(s):

John Snowdon

Keyword(s):

Bipolar Disorder ◽

Affective Disorder ◽

Age Of Onset ◽

Bipolar Affective Disorder ◽

Manic Episode ◽

Case Note ◽

Retrospective Case ◽

History Of ◽

Study Case ◽

Reason For Admission

In a replication of an earlier published study, case notes of 75 elderly in-patients with bipolar affective disorder were examined. Few of the patients had experienced a manic episode before the age of 40. Mean age of onset of affective disorder was 46 years, and first manic episode at 60 years. Cerebral insults before the first manic attacks were recorded in a substantial number of cases, and a family history of mental illness was less common among this group. Bipolar affective disorder is relatively common as a reason for admission of elderly patients.

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