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Bipolar disorder, cardiac comorbidity and therapeutic impasse: A case report

Published online by Cambridge University Press:  13 August 2021

I. Bouslama ,
H. Jemli ,
A. Ben Cheikh Ahmed ,
F. Nacef  and
R. Jomli
I. Bouslama
Affiliation:
Avicenne, manouba psychiatry, manouba, Tunisia
H. Jemli*
Affiliation:
Avicenne, manouba psychiatry, manouba, Tunisia Faculty Of Medicine Of Tunis, university of tunis elmanar, tunis, Tunisia
A. Ben Cheikh Ahmed
Affiliation:
Faculty Of Medicine Of Tunis, university of tunis elmanar, tunis, Tunisia
F. Nacef
Affiliation:
Avicenne, manouba psychiatry, manouba, Tunisia
R. Jomli
Affiliation:
Avicenne, manouba psychiatry, manouba, Tunisia Faculty Of Medicine Of Tunis, university of tunis elmanar, tunis, Tunisia
*
*Corresponding author.

Abstract

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Introduction

BipolarDisorders (BD) are regarded as a multidimensionaldiseaseinvolvingbothpsychological and physicaldeterminants. Althoughmood dimension andthymicinstability areconsidered as the « core » aspect of bipolardisorders, itis crucial to note thatsomaticproblemsfrequentlyoccur in BD,deeplyworsening the prognosis.

Objectives

Herewedescribea case of atwentyyearshistory of psychiatricimpairment, diagnosedlaterwithcardiac malformation.

Methods

Female patient H.G has been admitted for the first time to psychiatric department ‘A’ of Razi Hospital,treated for type 1 bipolar disorder since 2004 with poor therapeutic compliance. We reviewed the clinical and paraclinical data.

Results

The patient was hospitalized for a severe manic episode with psychotic features, without cardiac personal history. The patient was asymptomatic and physical examination showed no abnormalities. Following a routine electrocardiogram, an acute coronary syndrom was discovered (inverted T waves seen in V1 to V6). Cardiac troponins were not elevated. According to cardiology recommandations, ischemic heart disease could not be ruled out and extensive cardiovascular investigations were needed. Antipsychotics and mood stabilizors were contraindicated.Therefore, the manic episode could only be managed using benzodiazepines. Given contradictions between clinical, electrocardioagraphic and imaging findings,coronary angiography was necessary. Results showed no significant stenosis of coronary arteries and a myocardial bridging of the left anterior descending artery and we were able to put her on antipsychiotics and moodstabilizer, almost two months after her admission.

Conclusions

This case underlines the significant impact of somatic comorbidities in therapeutic management of bipolar disorders. Cardiovascular diseases in particular cause a delay in treatment initiation and an increase in patient length of hospital stay.

Disclosure

No significant relationships.

Keywords

bipolar disordercomorbiditycardiac disease
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S619
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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