Treatment resistant manic episode with commorbidity with borderline personality disorder (BPD)

A Sarafopoulos,V Karpouza,D Antoniadis

doi:10.1192/j.eurpsy.2021.1662

Abstract

IntroductionA 47 y.o. female patient was admitted to the female PICU with a manic episode. Upon admission she presented with mood elation, psychosis, pressured speech, lack of sleep and agitation.ObjectivesTo investigate negative prognostic factors such as the co-morbidity with a personality disorder in patients presenting with severe mania.MethodsThe patient was assessed regularly by the psychiatric team consisting of a CT doctor and one General Adult Consultant. Appropriate psychological assessments for mania and laboratory investigations took place.ResultsThe patient initially scored above 45 in the Young Mania Rating Scale (YMRS), establishing a diagnosis of severe mania. She was treated with Olanzapine titrated up to 20mg OD and augmentation with Lithium treatment. Lithium plasma levels were at 0,6. Due to the treatment resistant manic presentation a second antipsychotic agent was administered and the patient was also treated with Zuclopenthixol depot 400mg every two weeks. Clinical improvement was observed after 16 days from admission.ConclusionsThe clinical team wondered about the clinical challenges of the case. According to the literature having a Personality Disorder diagnosis is a negative prognostic factor for patients with mania and this is relevant to this case as well.DisclosureNo significant relationships.

Highlights

After ruling out organic and pharmacological causes of the polydipsia, the mental health team wondered about the cause of the symptom
IL-10 at manic episode was negatively correlated to general psychiatric symptoms, IL-4 positive correlated to depressive symptoms, and cognitive performance was positively correlated to TNFα and TNF- γ at follow-up
A 49 y.o. male patient was admitted to the male PICU with a manic episode

Summary

Cytokine MADRS BPRS

There was a referral to Endocrinology for further investigation of the symptom. Results: The patient initially scored above 40 in the Young Mania Rating Scale (YMRS), establishing a diagnosis of mania. Upon admission he was treated with Paliperidone 9mg OD and Sodium Valproate 1gr OD. Conclusions: After ruling out organic and pharmacological causes of the polydipsia, the mental health team wondered about the cause of the symptom. Further investigation is required in order to clarify whether the polydipsia could qualify as a symptom in severe mania. IL-10 at manic episode was negatively correlated to general psychiatric symptoms, IL-4 positive correlated to depressive symptoms, and cognitive performance was positively correlated to TNFα and TNF- γ at follow-up.

Introduction