Onset of bipolar disorder induced by treated COVID‐19 infection in a 44‐year‐old man with no psychiatric history

Abstract Akathisia is a relatively common adverse effect that may emerge during treatment with antipsychotics and other medication classes. We present a case of akathisia that may have been induced by the abrupt discontinuation of varenicline and review existing literature related to this phenomenon. A 46-year-old female with a past psychiatric history of bipolar disorder and borderline personality disorder was admitted to the acute psychiatric services department for suicidal ideation after 3 weeks of a new course of varenicline. This was prescribed for smoking cessation and titrated to 1 mg twice daily. Upon admission, the varenicline was discontinued. Roughly 3 days later, the patient began to complain of akathisia. The patient had experienced akathisia previously while taking antipsychotics for her bipolar disorder and was able to recognize its emergence. As the akathisia worsened, propranolol 10 mg 3 times daily was ordered and was effective in relieving her symptoms. A PubMed search using the terms varenicline, akathisia, withdrawal, and discontinuation was conducted. No literature of this phenomenon was found; however, reports of other extrapyramidal symptoms were noted. Considering the timing of varenicline's discontinuation and its mechanism, a pharmacological link between its use and akathisia is possible. Akathisia is a severely uncomfortable sequela of medications that may produce severe outcomes, such as suicidal ideation. In this case, it is possible that the discontinuation of varenicline after 3 weeks of therapy led to akathisia, which was successfully treated with propranolol.

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Dementia or Mania

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1088 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S651-S651

Author(s):

C. Gomez ◽

V. Rodriguez

Keyword(s):

Bipolar Disorder ◽

Frontotemporal Dementia ◽

Lithium Treatment ◽

Final Diagnosis ◽

Special Treatment ◽

Psychiatric Ward ◽

Psychiatric History ◽

Mood Changes ◽

First Case ◽

Competing Interest

BackgroundIn the clinical practice we encounter different clinical situations that require precise differential diagnosis and special treatment. This poster reviews the diagnosis and pharmacotherapy of two cases that points out how likely is to confuse the diagnosis of two apparently different pathologies, as are bipolar disorder and frontotemporal dementia. We study and compare two cases that were hospitalised in the psychiatric ward of Sant Joan's Hospital. Following their treatment and evolution. The first case is a 75-years-old man that presented behavioural changes, hypomania, and insomnia without previous known psychiatric history other than alcoholism. The family explained a history of episodes of mood changes going from depression to mania, compatible with a bipolar diagnosis never diagnosed, and the neuropsychological exam that was performed did not show any cognitive impairment finally receiving a diagnosis of bipolar disorder after the good response to the lithium treatment. In the second case we have a 58-years-old man with behavioural disturbances and mood fluctuation that changes from short periods of hypomania with disinhibition and insomnia to a predominance of hypothymia, apathy and self-care negligence, which received at the beginning a diagnosis of bipolar disorder and that after the proper complementary tests was shown to be a frontotemporal dementia.ConclusionsWhen facing behavioural and mood changes in advance age in the absence of psychiatric history we should take into account the considerable percentage of patients with a final diagnosis of frontotemporal dementia that received previously a mistaken diagnosis of bipolar disorder and vice versa.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Familial severe psychiatric history in bipolar disorder and correlation with disease severity and treatment response

Journal of Affective Disorders ◽

10.1016/j.jad.2020.03.157 ◽

2020 ◽

Vol 273 ◽

pp. 131-137

Author(s):

Ole Köhler-Forsberg ◽

Louisa G. Sylvia ◽

Valerie L. Ruberto ◽

Maya Kuperberg ◽

Alec P. Shannon ◽

...

Keyword(s):

Bipolar Disorder ◽

Treatment Response ◽

Disease Severity ◽

Psychiatric History

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The role of family and personal psychiatric history in postconcussion syndrome following sport-related concussion: a story of compounding risk

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.3.peds1850 ◽

2018 ◽

Vol 22 (3) ◽

pp. 238-243 ◽

Cited By ~ 8

Author(s):

Andrew D. Legarreta ◽

Benjamin L. Brett ◽

Gary S. Solomon ◽

Scott L. Zuckerman

Keyword(s):

High School ◽

At Risk ◽

Bipolar Disorder ◽

Psychiatric History ◽

Regression Analyses ◽

High School Athletes ◽

Postconcussion Syndrome ◽

Increased Risk ◽

Bivariate Regression

OBJECTIVESport-related concussion (SRC) has become a major public health concern. Prolonged recovery after SRC, named postconcussion syndrome (PCS), has been associated with several biopsychosocial factors, yet the role of both family and personal psychiatric histories requires investigation. In a cohort of concussed high school athletes, the authors examined the role(s) of family and personal psychiatric histories in the risk of developing PCS.METHODSA retrospective cohort study of 154 high school athletes with complete documentation of postconcussion symptom resolution or persistence at 6 weeks was conducted. PCS was defined as 3 or more symptoms present 6 weeks after SRC. Three groups were defined: 1) positive family psychiatric history and personal psychiatric history (FPH/PPH), 2) positive FPH only, and 3) negative family and personal psychiatric histories (controls). Three bivariate regression analyses were conducted: FPH/PPH to controls, FPH only to controls, and FPH/PPH to FPH. Post hoc bivariate regression analyses examined specific FPH pathologies and PCS.RESULTSAthletes with FPH/PPH compared with controls had an increased risk of PCS (χ2 = 8.90, p = 0.018; OR 5.06, 95% CI 1.71–14.99). Athletes with FPH only compared with controls also had an increased risk of PCS (χ2 = 6.04, p = 0.03; OR 2.52, 95% CI 1.20–5.30). Comparing athletes with FPH/PPH to athletes with FPH only, no added PCS risk was noted (χ2 = 1.64, p = 0.247; OR 2.01, 95% CI 0.68–5.94). Among various FPH diagnoses, anxiety (χ2 = 7.48, p = 0.021; OR 2.99, 95% CI 1.36–6.49) and bipolar disorder (χ2 = 5.13, p = 0.036; OR 2.74, 95% CI 1.14–6.67) were significantly associated with the presence of PCS.CONCLUSIONSConcussed high school athletes with FPH/PPH were greater than 5 times more likely to develop PCS than controls. Athletes with only FPH were over 2.5 times more likely to develop PCS than controls. Those with an FPH of anxiety or bipolar disorder are specifically at increased risk of PCS. These results suggest that not only are athletes with FPH/PPH at risk for slower recovery after SRC, but those with an FPH only—especially anxiety or bipolar disorder—may also be at risk. Overall, this study supports taking a detailed FPH and PPH in the management of SRC.

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