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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.

EV0196

Severe rebound mania following abrupt lithium discontinuation in a patient with long-term mood stability

SEVERE REBOUND MANIA AFTER SUDDEN LITHIUM WITHDRAWAL IN A PATIENT WITH LONG-TERM MOOD STABILITY

Abrupt discontinuation of lithium in a patient who had been in remission on lithium for ten years resulted in a severe, treatment-resistant, recurrent manic presentation in the form of delirious mania (Bell's mania).

This case report aims to illustrate severe rebound mania caused by abrupt lithium discontinuation in a patient with long-term mood stability. Informed consent was obtained from the patient in accordance with the Declaration of Helsinki; as of 2024, the 32-year-old male patient had a 15-year history of bipolar disorder and two psychiatric hospitalizations, and his maintenance regimen over the preceding ten years consisted of lithium 1200 mg/day, quetiapine XR 150 mg/day, and aripiprazole 5 mg/day. Treatment had been abruptly discontinued three months earlier because of long-term metabolic adverse effects. The patient presented with a decreased need for sleep, euphoric affect, disorganized speech and behavior, and paranoid, persecutory, referential, grandiose, and religious delusions, with a Young Mania Rating Scale (YMRS) score of 37. High-dose combination treatment comprising hypnotics, sedatives, and multiple antipsychotic agents was required for most of the 32-day hospitalization (haloperidol 10 mg IM twice daily and biperiden 5 mg IM twice daily for the first 5 days; clonazepam 1–2 mg twice daily, averaging 3.2 mg/day, for 16 days; zuclopenthixol 50 mg IM on days 3 and 12; and, from day 11 onward, lithium 1200 mg/day, aripiprazole 10 mg/day, quetiapine XR 400 mg/day, and risperidone 4 mg/day). Despite this intensive pharmacological intervention, the YMRS score was recorded as 22 on day 22 of hospitalization. According to hospital records, the patient was readmitted with a recurrent manic episode 49 days after discharge following a reduction in medication doses; during both hospitalizations, the manic episodes took the form of delirious mania (Bell's mania). The patient's functioning did not return to the level achieved during the previous long-term remission, and a substantially more intensive regimen than the initial maintenance treatment was required. The authors emphasize the need to avoid abrupt lithium discontinuation, adhere strictly to guidelines, and ensure close monitoring. They note that electroconvulsive therapy (ECT) is recommended as a first-line option for Bell's mania, that intensive benzodiazepine administration may be required until clinical stability is achieved, that atypical antipsychotics are preferred for maintenance treatment, and that maintenance monotherapy is not recommended.

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