Akademik Veri Yönetim Sistemi
Türkiye Psikiyatri Derneği Yıllık Toplantısı ve 1. Uluslararası 25. Ulusal Klinik Eğitim Sempozyumu, İzmir, Türkiye, 19 - 22 Mayıs 2022, ss.117
OBJECTIVE: Bipolar Affective Disorder(BAD) is a condition with
periods of mania, hypomania and depression. Mood fluctuations are
common during the process of disorder. The first episode of BAD is
generally depressive, and these episodes persist significantly longer
than manic or hypomanic episodes throughout the course of illness.
Patients diagnosed with unipolar depression should be asked whether
they have had a period when they were overactive, more talkative,
increased in goal-directed activity, and decreased need for sleep. We
aimed to present a case that was treated for 4 years with the diagnosis
of unipolar depressive disorder and then diagnosed as bipolar affective
disorder (BAD) unspecified type. Informed consent was obtained from
the patient for the case presentation.
CASE: The patient was a 46 year old male and married with his third
wife and had no additional disease. According to his medical records;
it was learned that he had been receiving antidepressant treatment for
four years with the diagnosis of major depressive disorder (MDD)
until he was admitted to our clinic. Despite the fact that the patient,
who uses his medications regularly and goes to the outpatient clinic
controls regularly, was hospitalized twice for four years, there was no
adequate improvement in his symptoms and psychococial functioning.
The patient was referred to our clinic with the preliminary diagnosis
of treatment-resistant MDD. When the patient is evaluated in detail;
it was learned that he had signs and symptoms such as psychomotor
agitation, decreased need for sleep, increased in appetite and irritability
every year during seasonal changes. On the other hand, his signs and
sympyoms never fulfilled the diagnostic criteria of manic or hypomanic
episode. Additionally, the patient's uncle and brother were found to
be suffering from BAD Type 1. Hence, his diagnosis was established
as bipolar affective disorder "unspecified type". The patient was
treated with sertaline 100 mg/per day, mirtazapine 15 mg/per day, and
aripiprazole 10 mg/per day before hospitalization. Considering the
diagnosis of BAD unspecified type, bupropion 300 mg/per day, lithium
900 mg/per day, valproic acid 1000 mg/perday was administered to the
patient. After the follow-up, it was observed that the patient's signs and
symptoms decreased. Hamilton depression rating scale(HDRS) scores
decreased from 29 to 7. Young Mani Rating Scale (YMRS) decreased
from 4 to 2.
DISCUSSION: The concept of bipolar spectrum is used to define
conditions between classic unipolar depression and BAD Type 1.
Recurrent depressions, family history of bipolar or antidepressantinduced mania, with no response to antidepressant treatment, mixed
and melancholic features, early onset of depression and more depressive
episodes, inadequate response to antidepressants, hyperthymic and
cyclothymic temperaments are features suggestive of bipolar spectrum.
We think that our case highlight importantance of diagnosis and
treatment for BAD spectrum. The diagnosis and treatment approach as
BAD spectrum were redefined due to the characteristics of our patient
such as seasonal sleep rhythm and mood changes, unresponsiveness to
antidepressant treatment, and the presence of a family history of bipolar
mood disorder. Thus, positive results were obtained in the follow-up
process of our case.
Keywords: bipolar affective disorder, depression, mood stabilizer