Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

Bipolar II With Associated Psychosis Yasmine Sanhaji, OMS-III, Dr.Mohammed Memon, MD 1. VCOM-Carolinas, Spartanburg, South Carolina.

Introduction

Results

Discussion

Table 1. The table demonstrates a comprehensive treatment approach for Bipolar II with associated psychosis, where initial adjustments in lithium and quetiapine dosages, combined with a consistent increase in Cognitive Behavioral Therapy (CBT) sessions, correlate with a steady reduction in symptom severity.

• Standardized assessments confirmed Bipolar II Disorder with psychotic features • Regular use of YMRS and DSM-5 CRDPSS enabled precise symptom tracking and treatment adjustments • Combined pharmacotherapy utilizing lithium and quetiapine demonstrated effectiveness • Long-term monitoring focused on medication side effects, particularly renal function with lithium and metabolic parameters with quetiapine • CBT sessions enhanced stress management capabilities • Individual therapy combined with medication produced effective results in managing mood disorder Conclusions • Investigate early warning signs and risk factors for psychosis in Bipolar II patients • Study demographic and clinical characteristics that may predict psychotic features • Create standardized approaches for complex psychiatric presentations • Implement comprehensive care models integrating physical and mental health • Develop individualized treatment strategies based on patient needs • Design structured outpatient monitoring protocols

Figure 1. Over the span of 21 days, the psychotic symptom severity score decreased significantly , showing a positive response to treatment Clinical Assessment: Patient presented with hypervigilance, AOx3, and pressured speech. Exhibited paranoid behavior, sitting on floor fearing others could hear thoughts. Observed talking to unseen others, quoting religious passages, with poor insight and judgment. Patient Information: 23-year-old female with cyclothymia history, admitted following acute psychotic episode triggered by romantic conflict. No significant medical, family, or substance use history. College-educated with previously stable psychosocial functioning This case presentation examines a complex presentation of Bipolar II Disorder with psychotic features in a 23-year-old female, highlighting the challenges of diagnosis and management when traditional risk factors are absent. The patient's acute-onset psychosis, triggered by romantic conflict, manifested through delusions, paranoia, and impulsive behaviors, despite her intact cognitive abilities. Through this analysis, we demonstrate the effectiveness of an integrated treatment approach combining pharmacotherapy with psychosocial interventions, while exploring the unique aspects of psychosis presentation in Bipolar II Disorder, particularly in young adults with minimal predisposing factors. Research Question: How do clinical markers and standardized assessments guide accurate diagnosis and treatment selection in young adults presenting with acute psychotic features without traditional risk factors for Bipolar II Disorder? Methods

Days of admission

Psychotic Symptom Severity Score

Lithium Dosage (mg)

Quetiapine Dosage (mg)

Number of CBT Sessions

Admission 9

450mg 900mg 900mg 900mg 900mg 900mg 600mg 600mg

0

0

Days 1-3 Days 4-6 Days 7-9

6 6 4

50-150mg x2 BID 3

300 mg 300 mg 300mg 300mg 300mg 300mg

6 9

Days 10-12 4 Days 13-15 2 Days 16-18 1 Days 19-21 0

12 15 18 21

Figure 2. This figure demonstrates improvement across multiple domains highlighting the multifaceted nature of both the illness presentation and treatment response.

Table 2. This table illustrates the patient’s journey from acute psychosis to stabilization demonstrating the effectiveness of multidisciplinary treatment in managing Bipolar II Disorder with psychotic features.

References

Day Clinical Observations

Interventions

Outcome Measures

Agitation, grandiose beliefs, no sleep

Initiated haloperidol, physical restraints Increased Lithium dosage, Quetiapine therapy started Continue medication and CBT therapy

1-3

YMRS: Severe

1.Howe, J., MacPhee, M., Duddy, C., et al. (2023). A realist review of medication optimisation of community dwelling service users with serious mental illness. BMJ Quality & Safety. doi: 10.1136/bmjqs-2023-016615 2. Rodgers, M. J., Zylstra, R. G., McKay, J. B., Solomon, A. L., & Choby, B. A. (2010). Adolescent bipolar disorder: a clinical vignette. Primary Care Companion Journal of Clinical Psychiatry, 12(4). 3. Tamminga, C. A., et al. (2013). Clinical phenotypes of psychosis in the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP). American Journal of Psychiatry, 170(11), 1263-1274

YMRS: Severe Moderate

4-6 Paranoid ideation

Decreased agitation, improved sleep Stabilizing symptoms, improved insight

7-9

YMRS: Moderate

10-12

Group therapy added

YMRS: Moderate

We would like to acknowledge Carolinas Behavioral Center for their dedicated comprehensive care in managing this complex case and their additional input for this report. We would also like to thank the patient for their consent for this report. Acknowledgements

13-15 Enhanced reality testing

Discharge planning begun

YMRS: Mild-Moderate

Improved self-care, social interaction

16-18

Medication adjustment

YMRS: Mild

Stabilized mood, medication adherent

19-21

Outpatient plan established YMRS: Minimal

2025 Research Recognition Day

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