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Bipolar disorder is a chronic mental disorder, often with onset at a young age. An estimated 4.4% of US adults experience bipolar disorder at some time in their lives.1 According to the National Comorbidity Survey Replication, the past-year prevalence of bipolar disorder in adults age ≥60 is 0.7%.1 An estimated 83% of people with bipolar disorder have serious impairment, which is the highest percentage of serious impairment among mood disorders.1 Bipolar I disorder affects men and women equally, whereas bipolar II disorder seems to occur more frequently in women.2 Symptoms of bipolar disorder include episodes of mania, depression, and mixed states.2
A variety of medications—including mood stabilizers, lithium, and antipsychotics (Table 1,3,4 and Table 2,4)—and somatic treatments such as electroconvulsive therapy and transcranial magnetic stimulation are used to manage the depressive and manic/mixed episodes of bipolar disorder. Treatment should be individualized based on the patient’s symptom severity, sensitivity, response to treatment, and preferences.
The most common reason for discontinuing a medication is intolerance to adverse effects. Some adverse effects are mild and may lessen over time. Others can be life-threatening. Thus, medications should be chosen carefully and started at low doses, and patients should be closely monitored for adverse effects at regular intervals.
Here I describe the case of a patient with bipolar disorder who developed hyponatremia while being treated with the second-generation antipsychotic lurasidone.
Continue to: CASE REPORT...