Lithium and endocrine dysregulation in decompensated bipolar disorder with psychotic features

Introduction: Bipolar disorder (BD) is a mood disorder characterized by manic episodes, depressive episodes, mixed states, and psychotic symptoms. It affects over 2% of the global population and is associated with higher suicide rates than the general population. Treatment options include antipsychotics, anticonvulsants, and lithium, which are effective for long-term management and suicide prevention. Lithium has long been the gold standard for BD treatment; however, it can cause thyroid and parathyroid dysfunction. Patients receiving medications for medical comorbidities can be at higher risk for side effects. Case Report: In this case, a 66-year-old female with bipolar I disorder and multiple endocrine abnormalities was admitted during a manic episode with psychotic features that followed their discontinuation of lithium. Conclusion: This case illustrates the complexities of managing BD with concurrent endocrine disorders and the importance of collaboration between specialty providers to maintain patient medical and psychiatric safety.