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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.

EV1360

Transition from a mood disorder to a psychotic disorder in the context of conflict in a romantic relationship between individuals of two nationalities during wartime: a case report

TRANSITION FROM AFFECTIVE TO PSYCHOTIC ILLNESS IN THE CONTEXT OF CROSS-NATIONAL ROMANTIC CONFLICT DURING WAR: A CASE REPORT

In a patient with bipolar I disorder who had been stable for years, a psychotic episode without prominent mood symptoms following war-related psychosocial disruption led to a revised diagnosis of schizoaffective disorder, bipolar type.

The aim of this presentation is to illustrate how wartime conditions can alter the clinical presentation and diagnostic course of a long-standing, stable mood disorder. The case concerns a 25-year-old man who was diagnosed with bipolar I disorder in 2017 following a manic episode with psychotic features, remained stable on quetiapine for an extended period, and was able to continue working. During his treatment course in 2017, escitalopram 5 mg was initiated for a depressive presentation; olanzapine 10–15 mg was prescribed for a manic episode that developed one month later, and he was subsequently switched to quetiapine because of depressive symptoms and hypersomnia. In October 2023, heightened national tensions associated with the war affected his romantic relationship, resulting in a breakup. During the same period, he was placed on unpaid leave because his workplace downsized owing to the security situation, and he began using cannabis daily for the first time to cope with stress. In November 2023, within days of manic symptoms, persecutory and referential delusions, suspiciousness, and disorganized thinking emerged without prominent mood symptoms. No significant response was achieved despite increasing quetiapine XR back to 200 mg and administering olanzapine 10 mg with lorazepam 1 mg, followed by haloperidol 5 mg with biperiden 2 mg, through a hospital-at-home service. During hospitalization in December 2023, quetiapine was gradually increased to 450 mg/day, olanzapine was tapered and discontinued, and the psychotic symptoms resolved after approximately one month of quetiapine treatment. As repeated inpatient assessments revealed no prominent mood syndrome, the diagnostic formulation was revised to schizoaffective disorder, bipolar type. The authors emphasize that a new non-affective psychotic episode warrants diagnostic reassessment even after years of stability; that the effects of war may operate indirectly through relationship conflict, job loss, isolation, and substance use rather than through direct trauma; and that long-term care should include psychosocial and family-focused interventions alongside pharmacotherapy.

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