Chronic, Unipolar, Treatment-Resistant Mania: A Case Report and Literature Review

[摘要] Aims. Chronic mania is variably defined but classically recognized as the presence of manic symptoms for more than 2 yearswithout remission. The reported incidence ranges between 6–15% among all patients with bipolar disorders. Although it hasbeen described in psychiatry literature for a long time, it hasnot yet found a place in current nosological systemsMethods. We present a 32-year-old single and unemployed manwho is supported by his family and living with a sudden-onset,continuous illness of 12 years’ duration characterized by a resistant and markedly euphoric and expansive mood with grandiosedelusions. Other features such as distractibility, pressured speech,racing thoughts and psychomotor disturbance remain significantbut vary and are more responsive to medical interventions.Psychotic symptoms are largely confined to mood-congruentdelusions, grandiose and religious, and are reported to have followed the mood disturbance from early on. There is no historyof substance use, past psychiatric or medical illness, or headtrauma and no evidence of a neurological cause on workup.This gentleman has been treated with a range of mood stabilizersand antipsychotics and two courses of ECT over the years. In therecent years, he has been on a combination of Clozapine,Valproate, and Pregabalin with relatively favorable but inadequateresponse and limited functional improvement.Results. Chronic mania lasting for 12 years, in the absence of anorganic cause, despite the use of a wide gamut of modern psychotropics, alone and in combination with ECT, and with adequatecompliance is an exceptionally rare entity. It poses manifold challenges both in terms of diagnostic considerations and therapeuticapproaches. The overlap of symptoms of mania, schizophrenia,and schizoaffective disorders along with chronicity adds a particular layer of complexity. The hallmark of chronic mania is euphoricand expansive mood along with grandiose delusions and the presentation is relatively less centered on sleep disturbance, hypersexuality, and psychomotor agitation as compared to an acutemanic episode. It is distinguished from schizophrenia spectrumdisorders as it lacks flat or inappropriate affect, incongruent delusions and disorganized thought. Course of illness, prior mood episodes and family history are important in differentiating froma schizoaffective pattern of disease.Conclusion. Unremitting mania of this duration is unique in itspsychiatric morbidity and devastating in its impact on the individual in terms of psychosocial functioning, quality of life, physical health and safety. It also brings unprecedented stress on thefamily and other support systems.

[学科分类] 计算机科学（综合）