PDF(Pubmed)
Abstract：
Bipolar disorder type 1 (BD-1) is a complex psychiatric disorder characterized by recurrent episodes of mania and depression. While manic episodes typically present with classic symptoms such as impulsivity, elevated mood, and increased energy, atypical presentations are not as common and when encountered may pose diagnostic challenges. In addition, multiple previous hospitalizations can prove for a more nuanced case with a potentially worse prognosis. This clinical case study explores the atypical clinical presentation of a 22-year-old Hispanic male with BD-1 and discusses the challenges associated with the correct diagnosis and recognition of this disorder. Typical BD-1 symptoms consist of depressive and manic episodes. The mania can encompass elevated mood, increased energy, racing thoughts, decreased need for sleep, grandiosity, and impulsivity. The typical depressive episodes consist of fatigue, low mood, loss of motivation, changes in appetite or weight, and even suicidal thoughts. Atypical symptoms consist of a mixture of both mania and depression at once, psychosis, present with seasonal patterns, anxious distress, catatonia, and rapid cycling of mood. The patient, with a medical history of BD-1, anxiety, polysubstance abuse, and multiple inpatient psychiatric hospitalizations presented to the emergency department via involuntary hold due to threats of suicidal behavior. Upon arrival, he presented with a myriad of typical and atypical acute manic symptoms including severe agitation, disorganization, anxiety, pressured speech, and rapid mood cycling. Throughout his admission he demonstrated extreme episodes of agitation, making threats of physical violence towards staff, attempting self-injury, behaving violently towards others, and displaying impulsivity as well as grandiosity despite receiving his long-acting injectable neuroleptic medication just three weeks prior to his hospitalization. Scheduled medication treatment during his inpatient hospitalization included a combination of risperidone, thorazine, divalproex sodium, mirtazapine, clonazepam, and temazepam. This clinical case underscores the importance of recognizing both typical and atypical presentations of manic episodes in BD-1 as well as the challenges involved in the treatment of a patient with severe and refractory symptoms requiring frequent hospitalizations.
摘要：
1型双相障碍（BD-1）是一种复杂的精神疾病，其特征是躁狂症和抑郁症的反复发作。虽然躁狂发作通常表现为冲动等经典症状，情绪升高，增加能量，非典型表现并不常见,遇到时可能会带来诊断挑战.此外,以前多次住院可以证明是一个更细微的病例，预后可能更差。本临床病例研究探讨了一名22岁的西班牙裔男性BD-1的非典型临床表现，并讨论了与正确诊断和识别该疾病相关的挑战。典型的BD-1症状包括抑郁和躁狂发作。躁狂症可能包括情绪激动，增加能量,赛车的想法，减少对睡眠的需求，宏伟，和冲动。典型的抑郁发作包括疲劳，情绪低落,失去动力，食欲或体重的变化，甚至自杀的想法.非典型症状包括躁狂和抑郁的混合，精神病,呈现季节性模式，焦虑的痛苦，紧张症,和快速的心情循环。病人,有BD-1病史，焦虑，多物质滥用，以及由于自杀行为的威胁，通过非自愿拘留将多个住院精神病患者提交给急诊科。抵达后,他表现出无数典型和不典型的急性躁狂症状，包括严重的躁动，杂乱无章,焦虑,有压力的演讲，和快速的情绪循环。在他承认的整个过程中，他表现出极端的激动，对员工进行人身暴力威胁，试图自我伤害,暴力对待他人，尽管在住院前三周接受了长效注射安定药，但仍表现出冲动和夸张。住院期间的预定药物治疗包括利培酮的组合，噻嗪,双丙戊酸钠,米氮平,氯硝西泮,还有替马西泮.此临床病例强调了识别BD-1躁狂发作的典型和非典型表现以及治疗患有严重和难治性症状需要频繁住院的患者所面临的挑战的重要性。
