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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0045

The bipolar spectrum and behavioral addictions: integrating psychoeducation, environmental controls, and combined pharmacotherapy in pathological gambling

BIPOLAR SPECTRUM AND BEHAVIORAL ADDICTIONS: INTEGRATING PSYCHOEDUCATION, ENVIRONMENTAL CONTROL, AND COMBINED PHARMACOTHERAPY IN PATHOLOGICAL GAMBLING.

In a case of co-occurring schizoaffective disorder and sports betting addiction, benzodiazepine-sparing pharmacotherapy combining low-dose lithium and depot aripiprazole, together with environmental and financial controls, achieved rapid clinical stabilization.

The aim is to present an integrated treatment approach in a case of dual pathology involving a severe psychotic spectrum disorder and a behavioral addiction. This is a case report; a 22-year-old male patient was voluntarily admitted to a dual pathology unit for severe sports betting addiction and stabilization of psychotic symptoms, and his 24-day inpatient course was monitored. History: sertraline 50 mg/day was initiated in April 2024 for depressed mood; olanzapine was initiated in July 2024 following an acute cannabis-induced psychotic episode with manic features, and was subsequently replaced with depot aripiprazole because of metabolic adverse effects (weight gain); a severe betting relapse resulting in substantial financial losses occurred in August 2025; and a crisis involving outwardly directed aggression toward objects led to a one-week involuntary acute psychiatric admission in January 2026. Urine toxicology screens remained consistently negative throughout admission. Severe sleep fragmentation unresponsive to mirtazapine improved after switching to trazodone 150 mg. Persistent requests for benzodiazepines (BZDs) were managed with a temporary scheduled regimen of levomepromazine drops rather than quetiapine or pregabalin because of a history of misuse, and the scheduled regimen was tapered and discontinued before discharge. Lithium 400 mg (in the evening) was added on February 16, 2026, for severe apathy–abulia and blunted affect; despite a subtherapeutic serum lithium level (0.33 mmol/L) on February 23, rapid improvements in motivation, mood, and apathy were observed. The discharge regimen consisted of lithium 400 mg (in the evening), aripiprazole 720 mg (monthly depot), trazodone 150 mg (in the evening), and 10 drops of levomepromazine as needed. In terms of insight into his addiction, the patient progressed from a precontemplative stage to partial insight, at which he could identify triggers. Planned safeguards against relapse included strict financial guardianship by a family member, a smartphone with internet access disabled, active registration in an international self-exclusion program, specialized psychotherapy twice weekly, and psychiatric follow-up. The authors emphasize that amotivation and executive dysfunction in schizoaffective disorder overlap with the reward deficiency mechanism of pathological gambling, that avoiding BZDs is critical in the context of dual misuse, and that temporary levomepromazine treatment provides a safe, non-addictive alternative in the inpatient setting.

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