Bipolar Disorder


Step 1: View clinicals

A 26 year old man presents with insomnia for 7 days, and excessive talkativeness and irritability to the point of aggression for 10 days. He claims to be a key advisor of the CEO of his company, and blames his wife for preventing him from attending work. However, his actual role is that of a data entry operator. There is no history of visual or auditory hallucinations. He experienced a similar episode of abnormal behaviour 2 months ago, which lasted for about one week. Subsequently, he was withdrawn and sad for several weeks afterwards. Medical attention was not sought at that time. His family history is significant for suicide by a maternal uncle in his 30s. The underlying condition, if any, is unknown. He only drinks socially and strongly denies drug abuse. Further inquiry from his family supports his assertions.

Step 2: Order all relevant investigations

Thyroid Profile

TSH: 2.7 mIU/L (0.4 - 4.0) Free T3: 144 ng/dL (100 - 200) FreeT4: 5.7 mcg/dL (4.5 - 11.2)

Fasting Plasma Glucose

Fasting Plasma Glucose: 98 mg/dL (70 - 100)

Renal Functions

Serum Creatinine: 0.9 mg/dL (0.7-1.3) BUN: 12 mg/dL (6 - 20)

Serum Electrolytes

Na+: 139 mEq/L (135 - 145) K+: 4.8 mEq/L (3.5 - 5.5) Cl--: 99 mEq/L (96 - 106)

Step 3: Select appropriate management

Electroconvulsive Therapy

Score: ★★☆