DefinePK

Research Objective

To present a case of Bipolar Affective Disorder (BPAD) in a young male patient with a known history of Achalasia Cardia, who was previously treated for depression and presented with a manic episode.

Methodology

Case report detailing a 22-year-old male patient with Achalasia Cardia and a history of depression. The methodology involved clinical presentation, psychiatric assessment including the Young Mania Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS), medical investigations (blood tests, CT scan brain), consultation with specialists (gastroenterologist, thoracic surgeon), and psychological investigations using psychometrics (YMRS, BPRS, Beck Depressive Inventory). Treatment involved a combination of sodium valproate, olanzapine, and clonazepam.

Methodology Flowchart

                        graph TD;
    A["Patient Presentation with Manic Symptoms"] --> B["Clinical Assessment & History Taking"];
    B --> C["Psychiatric & Psychological Investigations"];
    C --> D["Biological & Imaging Investigations"];
    D --> E["Specialist Consultations"];
    E --> F["Diagnosis: BPAD with Mania"];
    F --> G["Treatment Initiation"];
    G --> H["Symptom Monitoring & Follow-up"];
    H --> I["Treatment Adjustment & Tapering"];
    I --> J["Conclusion: Successful Management"];                    

Discussion

The case highlights the challenge of diagnosing psychiatric disorders in patients with chronic physical conditions like Achalasia Cardia. The authors emphasize the importance of ruling out organic and physical causes before making a psychiatric diagnosis. They suggest that patients with Achalasia Cardia may be predisposed to mental health problems due to their condition and treatment. The previous episode of depression was re-evaluated in the context of BPAD.

Key Findings

A 22-year-old male with Achalasia Cardia and a history of depression presented with symptoms of mania, including irritable behavior, aggression, over-talkativeness, ideas of self-importance, running away from home, and decreased sleep. His YMRS score was 22 and BPRS score was 50. After treatment with sodium valproate, olanzapine, and clonazepam, marked improvement in symptoms was observed within two weeks. His YMRS score reduced to 9 and BPRS score to 30 after one month. The diagnosis of BPAD with a current episode of mania with psychotic features was confirmed.

Conclusion

The case demonstrates that Bipolar Affective Disorder can co-occur with Achalasia Cardia and can be effectively managed with appropriate psychiatric medication. A comprehensive bio-psycho-social model and psychometric assessments are crucial for accurate diagnosis in such complex cases.

Fact Check

1. Patient Age: The patient is a 22-year-old male. (Confirmed in the text: "22-year-old known Achalasia cardia", "unmarried 22 years old male")
2. Previous Diagnosis: The patient was previously diagnosed with a moderate depressive episode in 2013. (Confirmed in the text: "diagnosed with a moderate depressive episode by a consultant psychiatrist in 2013")
3. Treatment Outcome: Marked improvement in symptoms occurred after two weeks of treatment. (Confirmed in the text: "Marked improvement in the symptoms occurred after two weeks of the treatment")

Mind Map