A RARE CASE OF EARLY-ONSET BIPOLAR AFFECTIVE DISORDER DURING LOCKDOWN
Dr Rupinder Gill, Department of Psychiatry, Vinayaka Mission’s Medical College & Hospital, Karaikal.
Introduction
• Lifetime prevalence of all adolescent
Bipolar Disorders (BD) varies from 0.1%
to 1% 1,2.
• The incidence rate of first onset mania in
clinical sample of youth range from 1.7 to
2.2 per 100,000 per year3.
• Both genetic4 and life events5 play a role
in the onset of BD.
• The typical age of onset of mood
symptoms is at 20 years6.
• Early onset - interaction model between
bio-psychological vulnerability and
environmental stressors.
• COVID-19 - psychological stressor.
• Trigger for early onset manic episode.
Case Report
11 year old male, studying in 6th std,
belongs to middle socio-economic status,
accompanied by his father, came with the
chief complaints of increased talkativeness
for 2 months and decreased need for sleep
for 4 days, precipitating factor being his
upcoming 6th standard final exams. It was
associated with lack of concentration,
inefficient thinking, irritability, poor recall
and anxiety. No significant past and
psychiatric history. Family history of
younger brother diagnosed with Borderline
Intelligence with moderate Autism and
ADHD. On general examination, patient was
found to be overweight.
Guided by Dr R. T. Kannapiran, Professor & HOD
Systemic examination was normal. He
presented with decreased self hygiene,
monotonous speech, anxious affect,
loosening of association, disorganized
thinking and absent insight. Both blood
tests and brain imaging were not suggestive
of a somatic cause explaining the symptoms.
He was diagnosed with schizophrenia first
and started on an atypical anti-psychotic
(Olanzapine). On his next visit, his mood
symptoms had worsened and he presented
with restlessness, tangentiality of ideas and
pressured speech. The diagnosis was
changed to Bipolar Affective Disorder and a
mood stabilizer (Oxcarbazepine) was added.
Benson Relaxation technique was advised.
Family psychoeducation and family-focused
therapy for adolescents was also done. His
YMRS score improved on subsequent visits.
He was later switched to Risperidone. At
present he has returned to his pre-morbid
level of functioning. He has finished his
exams and now has been promoted to 7th
standard.
• COVID-19 pandemic - biggest stress factor
• All the implications of this period, such as
Benson’s Relaxation Technique
Sample of his writing:
Before treatment & After treatment
Discussion
on mental health.
lockdown measures and widely spread fear
of contagion, determined the increase of
children and adolescents needs in
Psychiatry care.
• The described case report follows the
interaction between bio-psychological
vulnerability and environmental triggers to
develop psychopathology.
• Further researches on this interactive model
should be pursued in the light of the COVID-
19 pandemic.
• The rapid symptoms remission needs
particular attention: raising awareness
programs on early stage symptoms seem to
appear crucial in adolescent psychiatry in
order to assure rapid intervention and
treatment.
References
1. Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne
BJ, et al. (2003) Prior Juvenile Diagnoses in Adults
With Mental Disorder. Arch Gen Psychiatry 60: 709.
Link: https://bit.ly/38hJfJj
2. Lewinsohn PM, Klein DN, Seeley JR (1995) Bipolar
Disorders in a Community Sample of Older
Adolescents: Prevalence, Phenomenology, Comorbidity,
and Course. J Am Acad Child Adolesc Psychiatry 34:
454-463. Link: https://bit.ly/31zcLc8
3. Soutullo CA, Chang KD, Diez-Suarez A, Figueroa-
Quintana A, Escamilla-Canales I, et al. (2005) Bipolar
disorder in children and adolescents: international
perspective on epidemiology and phenomenology.
Bipolar Disord 7: 497-506. Link:
https://bit.ly/2YSLwrD
4. Craddock N, Jones I (1999) Genetics of bipolar
disorder. J Med Genet 36: 585- 594. Link:
https://bit.ly/2BUT2sK
5. Johnson SL, Cueller AK, Ruggero C, Winett-Perlman C,
Goodnick P, et al. (2008) Life events as predictors of
mania and depression in bipolar I disorder. J Abnorm
Psychol 117: 268–277. Link: https://bit.ly/38fTbmG
6. Kaplan & Sadock's Comprehensive Textbook of
Psychiatry. Philadelphia :Lippincott Williams &
Wilkins, 2000.