Case Report of Bipolar Disorder with Substance Use Disorder; Comorbidity or Confounders?

Abstract

Objective: Bipolar disorder commonly presents with substance use and there is the diagnostic challenge of one being a sequela of the other or the two being co-morbid conditions. The distinction is important as the effective treatment of the primary condition can lead to a concomitant remittance of the other. A misdiagnosis and a consequent ineffective treatment on the other hand, can lead to worsening prognosis of both conditions in the person. This aims at bringing attention to this diagnostic dilemma and the need to hone skills for proper diagnosis and eventual effective treatment.Case Presentation: Ms. KK is a 28-year-old divorcee and Human Resources Manager who presented with gregariousness, sleep difficulty and smoking of marijuana for two months. She had resumed smoking of marijuana after some 6 months break. She admitted to suicidal ideation and behaviours even though she also had many big plans to transform mental healthcare in Ghana. She was admitted a year earlier as schizophrenia for less than a week after which she had a divorce. Ms. KK was referred for management of substance induced psychosis to include residential rehabilitation. She was managed after review for bipolar disorder with substance use disorder. She was treated with long-acting second generation antipsychotic and she quit smoking with the remission of her mood symptoms after two months.Conclusion: Mood disorders can occur with substance use disorder as a co-morbid condition or part of the symptomatology of mood disorder. Substance use disorder can also present with mood symptoms or unmask mood disorders. When the correct diagnosis of aprimary mood disorder, bipolar disorder in this case, with co-morbid substance use disorder is made, effective treatment of the mood disorder can remit substance use.