27th National Clinical Education Symposium Presentation Abstracts

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The association between serum clozapine and norclozapine levels and metabolic parameters in patients with schizophrenia - Page S170
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Neurobiological Evidence Of Lithium Response And Non-Response: A Resting-State Functional Magnetic Resonance Imaging Study With Bipolar Disorder Patients - Page S4-5
Elif Sen, Mehmet Cagdas Eker, Ali Saffet Gonul, Ömer Kitiş, Seda Eroglu

29 APRIL 2025, MONDAY
13:00-14:00 POSTER PRESENTATION SESSION-2

ECT In Treatment-Resistant Mixed Manic Episodes

Burcu Kılıç Göçhasanoğlu1, Aslıhan Bilge Bektaş1, Esin Erdogan1

1. Izmir City Hospital

DOI: 10.5080/kes27.abs143 Page 169
OBJECTIVE:Bipolar disorder (BD) is a common and recurrent psychiatric illness, often challenging to diagnose. Mixed features involve simultaneous depressive and manic symptoms, leading to worse prognosis, higher treatment resistance, increased suicide risk, and greater comorbidities. Treatment options remain limited, with atypical antipsychotics, novel anticonvulsants, and electroconvulsive therapy (ECT) being primary choices. CASE (The patient consent must be provided and specified with appropriate terms.):A 39-year-old unemployed single male with bipolar I disorder for 18 years presented with irritability, insomnia, excessive spending, and anxiety. Over the past year, he had been hospitalized 15 times and showed persistent symptoms despite treatment. He had been on valproate (2500 mg/day), lithium (600 mg/day), quetiapine (600 mg/day), lamotrigine (50 mg/day), aripiprazole (20 mg/day), diazepam (5 mg/day), and recently started clozapine (25 mg/day). Due to ongoing anxiety and tremors, ECT was initiated. Lithium, valproate, and aripiprazole were gradually tapered off. After 4 ECT sessions, Young Mania Rating Scale (YMRS) scores dropped from 19 to 10. The patient completed 8 ECT sessions and was stabilized on quetiapine (400 mg/day) and valproate (1500 mg/day), with significant improvement in mood and reduced tremors. YMRS score was 2 at discharge. Informed consent was obtained from the patient for the publication of this case report. DISCUSSION:Mixed manic episodes differ from classic mania due to dominant depressive symptoms, requiring careful differential diagnosis. Pharmacotherapy is challenging, as treatments for one pole may worsen the other. ECT is highly effective in treatment-resistant cases, with response rates between 56% and 93%. This case highlights the limitations of polypharmacy and the efficacy of ECT in severe mixed episodes. Treating mixed episodes is complex, requiring both mood stabilizers and antipsychotics. Antidepressants should be used cautiously. ECT remains a crucial option for resistant and severe cases.