Manic episode in patient with bipolar disorder and recent multiple sclerosis diagnosis

Abstract

Introduction/Rationale: Multiple sclerosis (MS) is associated with a higher prevalence of mood and psychiatric disorders, such as bipolar disorder (BD). While mania is most often associated with BD, MS can also induce manic symptoms. However, it is crucial to distinguish which condition is causing mania since medical management is different based on its etiology. Herein, we report a case of a manic episode in a middle-aged female with a prolonged history of BD who received a recent diagnosis of MS 1 year ago. Patient Concerns: A 56-year-old female presented with an episode of mania and psychosis while receiving a phenobarbital taper for chronic lorazepam use. She had a prolonged history of bipolar type 1 disorder and depression. She showed optic neuritis and was diagnosed with MS a year prior. Diagnoses: The patient was diagnosed with BD-induced mania based on the absence of increased demyelination compared to previous MRI and lack of new focal or lateralizing neurologic findings of MS. Interventions: Lithium was given for mood stabilization and decreased dosage of prior antidepressant medication. Risperidone was given for ongoing delusions. Outcomes: After 8 days of hospitalization, patient's mania improved but demonstrated atypical features and ongoing delusions. She was discharged at her request to continue treatment in an outpatient setting. Conclusion/Lesson: In BD patients with an episode of mania, MS should be included in the differential, since both conditions can cause manic symptoms. The origin of mania should be delineated through a detailed neurological exam, neuroimaging, and thorough patient-family psychiatric history for appropriate clinical treatment.

A Grave Set of Diagnoses: A Case of Mania with Comorbid Autoimmune Thyroiditis Precipitated by Multiple Sclerosis Treatment

“…For patients diagnosed with both BD and MS, there is often no clear method for distinguishing whether mania is induced from BD or from an MS flare. 46 The link between psychiatric disturbance and thyrotoxicosis was first described in the 19th century. 47 Although overt psychosis is not often seen in patients with thyrotoxicosis, it is important to recognize the phenomenon.…”

“…The prevalence of BD in MS patients has been reported as twice that of the general population. For patients diagnosed with both BD and MS, there is often no clear method for distinguishing whether mania is induced from BD or from an MS flare 46 …”

Glycogen Synthase Kinase-3 Inhibitors: Preclinical and Clinical Focus on CNS-A Decade Onward

“…A retrospective study of US veterans with MS did not detect a consistent improvement in disease symptoms after lithium treatment (Rinker et al, 2013), although a later study reported that low-dose lithium treatment was well tolerated by MS patients and provided a "favorable" improvement on a quality of life scale (QOL) (Rinker et al, 2020). Lithium could also improve mania episodes in MS patients (Yang and Wichser, 2020). One of the few studies examining GSK-3 in human MS reported increased expression of GSK-3β in the corpus callosum and cerebral cortex of chronic progressive MS patients (Booth et al, 2005).…”