A Veteran with PTSD and Bipolar Disorder Type I with Psychotic Features

This case discusses a 33-year-old transgender Army Veteran, diagnosed with co-occurring Bipolar Disorder Type 1 (Bipolar I) and Post-Traumatic Stress Disorder (PTSD), both with psychotic features. The patient exhibited recurrent mood swings, delusions, auditory hallucinations, and passive suicidal thoughts. Concurrent symptoms, such as disrupted sleep, irritability, and intrusive thoughts, complicated diagnosis and treatment. The patient’s medical history included migraines, chronic pain, medication-induced seizures, traumatic brain injury (TBI), and Borderline Personality Disorder. During the assessment, the patient displayed mood fluctuations, cognitive issues, and intermittent tearfulness. They were averse to sedative medications and preferred non-pharmacological approaches. The Alpha-Stim (Cranial Electrical Stimulator – CES) was recommended for anxiety, depression, insomnia, and chronic pain. Medication options (Aripiprazole, Lurasidone, and Risperidone) were discussed, and the patient chose Aripiprazole. The treatment plan included Dialectical Behavior Therapy for Borderline Personality Disorder and potential polysomnography to evaluate sleep disorders. This case underscores the management challenges of co-occurring Bipolar I and PTSD with psychotic features, emphasizing the need for further research on their interplay, impact on functioning, and optimal treatments. It also explores CES as a potential intervention for psychosis during mood episodes. Funding No Funding