From the Guidelines
The patient's presentation suggests a complex interplay of factors, including untreated bipolar disorder, PTSD, dehydration, and substance use, which likely contributed to her acute episode, and therefore, prioritizing her psychiatric treatment and stabilization is crucial. The patient's symptoms, including feeling "weird," pre-syncope, and hallucinations, can be attributed to a combination of her underlying psychiatric conditions and the precipitating factors of dehydration and THC use 1. It is essential to consider the potential impact of her trauma history on her mental health and the possible triggering effect of the plasma donation experience.
Given the patient's history of bipolar disorder and PTSD, it is critical to address her psychiatric treatment and ensure that she is adhering to her medication regimen. The patient's report of not being on her bipolar medications suggests a potential lapse in treatment, which may have contributed to her acute episode. The use of mood stabilizers, such as lithium, valproate, or lamotrigine, may be beneficial in managing her bipolar symptoms, and adjunctive therapy with antipsychotics or antidepressants may be necessary to address her PTSD and depressive symptoms 1. However, caution must be taken when prescribing antidepressants, as they may destabilize the patient's mood or incite a manic episode 1.
The patient's use of THC during the acute episode is also a concern, as it may have exacerbated her symptoms. Abstinence from substance use, including THC, is recommended to prevent further destabilization of her psychiatric conditions. Additionally, addressing the patient's trauma history and providing her with appropriate support and therapy, such as cognitive-behavioral therapy (CBT) or trauma-focused CBT, may be essential in managing her PTSD symptoms and preventing future episodes.
In terms of management, a comprehensive treatment plan should be developed, incorporating psychiatric medication, psychotherapy, and lifestyle modifications to address the patient's dehydration and substance use. Regular follow-up appointments and monitoring of her psychiatric symptoms and medication adherence are crucial to prevent future episodes and ensure her overall well-being.
From the Research
Patient Presentation
The patient presents for follow-up after a brief hospital stay, reporting a recent episode where she felt "weird" and nearly passed out after donating plasma. She attributes this episode to a combination of factors, including not eating prior, feeling dehydrated, and potentially a manic episode coupled with her post-traumatic stress disorder (PTSD) due to not being on her bipolar medications.
Reported Symptoms and Triggers
- The patient reports that she "lost it" and started hallucinating, seeing her uncle who had raped and molested her at the age of 9.
- She mentions that her boyfriend gave her THC at this time, which may have contributed to her symptoms.
- The patient says she "blacked out," indicating a possible dissociative episode or loss of consciousness.
Relevant Studies
Studies such as 2 highlight the importance of early diagnosis and treatment of bipolar disorder, which can affect approximately 8 million adults in the US. The study also notes that more than 50% of patients with bipolar disorder are not adherent to treatment, which can lead to a reduced life expectancy and increased risk of cardiovascular mortality.
Treatment Considerations
- Research such as 3 and 4 suggests that lithium and valproate are effective mood stabilizers for the management of bipolar disorder, with lithium being particularly effective in treating acute mania and preventing both manic and depressive episodes.
- However, studies like 5 indicate that there may not be significant differences in efficacy between valproate and lithium when used as monotherapy or in combination with atypical antipsychotics.
- The patient's PTSD and history of trauma may also play a role in her symptoms, as noted in 6, which highlights the complexity of treating bipolar disorder patients with comorbid PTSD.
Potential Biomarkers
- The study 6 found that platelet-brain-derived neurotrophic factor (BDNF) levels were significantly reduced in depressed bipolar patients, suggesting that BDNF may be a potential biomarker for detecting depression in bipolar disorder patients.