Bipolar Disorder, Manic Episode With Psychosis

Introduction Bipolar disorder - chronic and hereditary condition that causes recurrent mood and energy fluctuations, including manic and hypomanic episodes. [1] Substance use disorders are among the most common comorbidities in individuals with mood disorders, including bipolar disorder. [2] Case Presentation A 34-year-old male was admitted to the hospital due to aggressive behavior in public. In his own words, he was "feeling wonderful." The patient's father has a history of alcohol addiction, and his mother died by suicide eight years ago. He was first admitted to a psychiatric hospital following his mother’s suicide due to inappropriate behavior, elevated mood, grandiosity, and insomnia. A few years later, he was diagnosed with bipolar disorder. No documented history of depressive episodes was found. However, the patient reports perceiving himself as unwell since adolescence, when he occasionally struggled with motivation for studying and social interactions. He had not been taking his prescribed medications regularly. Relapses may be associated with psychoactive substance use, as he has a history of 17 years of cannabis use, 15 years of MDMA use, 12 years of amphetamine use, and 5 years of cocaine use. The patient had been smoking cannabis weekly, with the last use occurring two days prior to hospitalization. On examination, the patient exhibited psychomotor agitation, elevated mood, inappropriate behavior, and affect. His thinking was rapid, and he lacked insight into his condition. A diagnosis of F31.2 was made. Diazepam, haloperidol, clozapine, and lithium carbonate were prescribed, and non-pharmacological treatment was initiated. During treatment, the patient’s condition gradually improved, and after 23 days, he was discharged from the hospital. Discussion The relationship between substance use and bipolar disorder is complex, often making diagnosis, treatment, and recovery challenging. Substance use can trigger mood episodes, while bipolar symptoms like impulsivity can drive substance use. [2] Intoxication or withdrawal may mimic mood episodes, complicating diagnosis. Effective treatment requires an integrated approach, as substance use can interfere with bipolar medications and therapy. [3] Conclusions Bipolar disorder is hereditary, but psychoactive substances can trigger or accelerate its onset.