Abstract
The article presents a case report of Mr. C, a 62-year-old man with bipolar affective disorder who presented to the emergency department of our tertiary care hospital four times within a seven-month period, resulting in multiple admissions. Throughout this period, he remained at home for a maximum of two weeks before re-presenting with tachypnea, disorganized behavior, depression, anxiety, and suicidal ideation. The consultation-liaison psychiatry service has been involved in his care during each presentation. He is a man who had been diagnosed with bipolar disorder in his twenties who had achieved clinical stability on lithium for multiple decades. After stopping lithium because of medical complications, he began to experience more frequent and severe mood episodes with concomitant decline in cognitive function associated with bizarre behavior that sometimes included features of catatonia. Between June 2015 and February 2016, he underwent two medical admissions for altered mental status with very broad workups, all of which were inconclusive. During this same period he also underwent three psychiatric admissions for symptom management, possible catatonia, and reported low mood with suicidality. After receiving ECT treatment and olanzapine on his final admission, he became calmer, was slightly less depressed, and was no longer suicidal. He did not regain has premorbid cognitive functioning, however, and continued to require close supervision and support from his wife.