Quetiapine in acute mania: a case report (with a six-month follow-up)

Quetiapine is an effective and well-tolerated antipsychotic. To date, experience with quetiapine in bipolar disorders is very limited and information on the use in acute patients is lacking. A patient with a DSMIV diagnosis of acute mania intolerant to lithium and to neuroleptics was treated with quetiapine. The daily dosage of quetiapine was gradually titrated up to 600 mg t.i.d. Quetiapine was effective, as evidenced by rating scale scores of the BPRS, YMRS and CGI, which dropped by 91% and 94% respectively from baseline (devoid of relevant side-effects). Quetiapine seems to be a promising agent for the treatment of manic episodes in bipolar disorders, although controlled trials are needed.     

Chronic but not resistant mania: a case report

OBJECTIVE: There are many nuances of elevated mood states. At times, it becomes very difficult to diagnose a case of mania because of personality style of the patient superimposed on a cyclothymic or hyperthymic temperament. Such cases may become chronic if timely intervention is not received. We describe a case of chronic mania of 48 years of duration. METHOD: A case report. RESULTS: A 65-year-old male was admitted with history of mania for around five decades. The illness commenced at prepubertal age and was continuous without any residual symptoms of note. During the course of illness, he got involved in many devastating socio-politico-legal complications. He showed good response to treatment and is currently maintained well without medication. In this case we also described some psychosocial features that may have been responsible for the chronicity of the illness. CONCLUSION: We highlighted the need for correctly identifying chronic mania, early intervention and increasing treatment awareness. This case was not treatment resistant, suggesting that chronicity per se should not denote poor outcome.     

Organic mania induced by phenytoin: a case report

Organic Mood Disorder of the manic type is a syndrome which resembles a manic episode but is due to a specific organic factor. Organic mania may be associated with a variety of physical illnesses such as temporal lobe epilepsy, multiple sclerosis, neoplasms and hyperthyroidism. In addition, organic mania can be associated with drugs including L-dopa, decongestants, sympathomimetics, steroids, baclofen withdrawal, cimetidine, and possibly captopril. This report describes a case of a 74 year old female who presented with a full syndrome of mania soon after being started on phenytoin. Neither the clinical picture, Mini-mental state score, nor EEG findings were suggestive of delirium. The syndrome resolved soon after the phenytoin was discontinued. This case suggests that phenytoin should be added to the list of medications capable of producing Organic Mood Syndrome, manic type.     

Marijuana-induced mania in a healthy adolescent: a case report

Marijuana is the most commonly used illegal substance by adolescents in the United States. According to a 2009 survey conducted by Monitoring the Future, there were about 11.8% of 8th graders, 26.7% of 10th graders and 32.8% of 12th graders who had abused marijuana at least once in the year (Johnston L.D., Bachman J.G., O'Malley P.M., Schulenberg J.E. Monitoring the Future: A Continuing Study of American Youth (12th-Grade Survey), 2009 [Computer file]. ICPSR28401-v1. Ann Arbor, MI: Interuniversity Consortium for Political and Social Research [distributor], 2010-10-27. doi:10.3886/ICPSR28401). A retrospective review of published literature disclosed case reports of marijuana-induced mania in adult patients with no prior psychiatric history (Bonnet U., Chang D.I., Wiltfang J., Scherbaum N., Weber R. A case of cannabis-induced mania. Fortschr Neurol Psychiatr. 2010 Apr; 78(4):223-5. Epub 2010 Feb3; Henquet C., Krabbendam L., de Graaf R., ten Have M., van Os J. Cannabis use and expression of mania in the general population. J Affect Disord. 2006 Oct;95(1-3):103-10. Epub 2006 Jun 21). To the best of our knowledge, this is the first report to document that marijuana induced manic symptoms in an adolescent with no known prior psychiatric history.     

Quetiapine vs. risperidone in treating psychosis in neurosyphilis: a case report

OBJECTIVE: A 44-year-old male patient presented with agitation, auditory hallucinations, and delusions of persecution was diagnosed as having neurosyphilis. METHODS: He was treated with penicillin G 24 million units/day, risperidone 6 mg/day, and memantine 20 mg/day with partial response to psychotic symptoms and significant extrapyramidal symptoms. RESULTS: On his follow-up, after 5 months, his cognitive status and serological tests remained the same, and his cell count was increased. A second therapy of penicillin was administered without any clinical improvement. On his second hospitalization for severe psychotic agitation after approximately 1 year, quetiapine 1200 mg/day was introduced and the psychiatric state improved immediately without significant side effect. CONCLUSIONS: Quetiapine, which has a low potential for producing extrapyramidal side effects, should be considered in the treatment of psychotic symptoms of neurosyphilis.     

High-dose fluoxetine-induced mania. Review and case report

We report the case of a 53 year old woman who attempted suicide taking one high-dose of fluoxetine, developing a manic episode 19 days later. We also make a review about antidepressant-induced mania. In patients with mood disorder, the frequency of antidepressant-induced mania switch has been estimated to be 3.7 to 33%, varying across studies that included different diagnoses and different antidepressant treatments. Among the used data basis (Medline) there are papers reporting fluoxetine-induced mania. All of them include patients receiving adequate dose and time fluoxetine treatment. We found no reports of switch occurring after one high-dose of fluoxetine. As the impact on the clinical management of antidepressant-induced manic switches is quite high, several studies have focused on the possible clinical predictors of this phenomenon. By the time, is not possible to determine whether a manic episode is due to the natural course of bipolar disorder or to the medication. Thus, the phenomenon of antidepressant-induced mania should be defined and investigated with controlled prospective studies.     

Carbamazepine-induced mania in two children: case report

Carbamazepine-induced mania is described in two case reports of prepubertal boys, one of whom also developed manic symptoms after receiving imipramine and dextroamphetamine. The structural and chemical similarities between carbamazepine and polycyclic antidepressants are discussed and it is suggested that caution and close observation be employed when using carbamazepine to treat children who have been identified as being at risk for developing this adverse effect.     

Recognizing thyrotoxicosis in a patient with bipolar mania: a case report

Background

A thyroid stimulating hormone level is commonly measured in patients presenting with symptoms of mania in order to rule out an underlying general medical condition such as hyperthyroidism or thyrotoxicosis. Indeed, many cases have been reported in which a patient is initially treated for bipolar mania, but is later found to have a thyroid condition. Several case reports have noted the development of a thyroid condition in bipolar patients either on lithium maintenance treatment or recently on lithium treatment.

Case presentation

We review a case in which a patient with a long history of bipolar disorder presents with comorbid hyperthyroidism and bipolar mania after recent discontinuation of lithium treatment.

Conclusion

Physicians should consider a comorbid hyperthyroidism in bipolar manic patients only partially responsive to standard care treatment with a mood stabilizer and antipsychotic.     

Quetiapine in the treatment of acute mania

Quetiapine is an atypical antipsychotic that has shown efficacy in the treatment of positive and negative symptoms in schizophrenia without causing extrapyramidal symptoms (EPS). To date, there are two monotherapy and two combination therapy studies with a double blind, placebo-controlled design on the use of quetiapine in mania. Several open studies and case reports support the results of the controlled trials suggesting that quetiapine is effective in treating the broad spectrum of manic symptoms and is tolerated well.