Management of Poor Treatment Adherence in Teenage-Onset Bipolar I Disorder Using Long-Acting Injectable Second-Generation Antipsychotics: A Case Report

Bipolar disorder is a chronic episodic illness in which poor treatment adherence is a major contributor to relapse, repeated hospitalization, and functional decline. We report the case of a 22-year-old self-employed man, diagnosed with bipolar I disorder at 16 years of age, who presented with irritability, aggressive behavior, reduced need for sleep, and increased goal-directed activity. He had experienced multiple manic and depressive episodes over a six-year period, largely related to repeated discontinuation of oral psychotropic medications following symptomatic improvement, and had a positive family history of mood disorder. During the current episode, clinical stabilization was achieved with electroconvulsive therapy and oral pharmacotherapy, after which a long-acting injectable second-generation antipsychotic paliperidone was initiated at discharge, and a two-year follow-up was done with clinical visits till date to address persistent non-adherence. This case highlights the potential role of long-acting injectable antipsychotics in improving treatment continuity and reducing relapse risk in selected patients with bipolar I disorder and a history of poor adherence.