2 results
Diagnostic difficulties in bipolar disorder type II
- L. Núñez, C. A. del Val, A. F. Merlos, E. X. G. Vivero, C. C. Carrascosa, M. H. Naval
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S702
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- Article
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Introduction
Bipolar disorder is one of the top 10 medical causes of disability according to the WHO and despite this, its diagnosis can be delayed up to 10 years after the appearance of the first symptoms of the disease. A major reason for the difficult diagnosis is the challenge of differentiating bipolar disorder type II from unipolar depression and borderline personality disorder, especially in those patients with no clear history of hypomania.
ObjectivesTo present a case report of a bipolar disorder undiagnosed for years to remark the importance of recognizing premorbid symptoms of the disease in order to implement an early intervention that potentially improves the prognosis of patients.
MethodsWe compiled the patient’s complete medical history and we carried out a non-systematic review of literature containing the key-words “bipolar disorder type II” and “diagnosis”.
ResultsWe present the case of a 48-year-old woman going through a depressive episode, multiple suicide attempts and more than 10 admissions in the Acute Inpatient Psychiatric Unit. For 3 years, the evolution was torpid with a significant multidomain cognitive impairment in a previously functional patient. Different antidepressant treatments were tested, however they were not tolerated due to adverse effects such as anxiety, insomnia and nervousness. After considering multiple differential diagnoses, bipolar disorder type II was finally diagnosed. A hypomanic episode that took place after 3 sessions of electroconvulsive therapy during an admission for depression, allowed to guide the diagnosis and after the introduction of Lithium and Quetiapine as treatment, the patient experienced a complete remission of the symptoms.
Conclusions1. It is important to consider the differential diagnosis of bipolar disorder type II due to its impact on the patient´s life.
2. An early diagnosis improves the course and prognosis of the disease.
3. Patients resistant or intolerant to antidepressant treatment could have undiagnosed bipolar disorder.
Disclosure of InterestNone Declared
Expectations in the treatment of delusional disorder: A case report
- A. Fuentes Merlos, C. Arroyo del Val, E. X. González Vivero, L. Núñez Cantos, A. Francos Ajona
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S965
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
We present the case of a 43 year-old woman that, following the sudden death of his brother in 2015, begins with symptoms of anxiety, irritability and emotional instability, with a tendency to social isolation. Thereafter, she starts the development of persecutory delusions focused on the work and family environment that evolve into inappropriate behaviors to the point of abandoning her professional life.
Objectives(1) We will carry out a complete review about persecutory delusions and its relationship with affective disorders, based on the severity of our patient’s case.
(2) We will study the different lines of treatment in delusional disorder (DD) and its course and prognosis in relation to the intervention performed.
MethodsA review of the patient’s history will be conducted, taking into account her biography, clinical evolution and response to the treatments received.
Likewise, a bibliographic review of the available scientific literature in relation to DD treatment strategies will be carried out.
Results(1) DD is more common in middle-aged women. People who tend to be socially isolated are more likely to develop DD.
(2) Acute onset, in young women with identifiable precipitating factors, suggests a better prognosis.
(3) In the long term, 50% of patients recover and a further 20% experience some improvement.
(4) The combination of antipsychotic medications and psychological therapies such as cognitive behavioral therapy (CBT) is fundamental in the management of DD patients.
ConclusionsThe prognosis for patients with DD varies depending on various factors, including the type and severity of the delusional ideas, and their own life circumstances. It is often possible to eliminate the behavioral alterations derived from the DD, allowing the patient to function normally. However, delusions often persist and become encapsulated.
Disclosure of InterestNone Declared