Communication and Handoff Errors Within Treatment-Resistant Bipolar I Disorder

Area of Science:

• Psychiatry
• Geriatric Medicine
• Healthcare Management

Background:

• Bipolar I disorder (BPD I) management is challenging due to acute manic episodes characterized by risk-taking and impulsivity.
• Disruptions in patient care and healthcare systems frequently complicate BPD I treatment.
• Treatment resistance in BPD I can be exacerbated by comorbidities and patient-systemic factors.

Observation:

• A 69-year-old male with BPD I, generalized anxiety disorder, and severe tobacco use disorder was involuntarily committed due to manic symptoms including delusions and inappropriate sexual behavior.
• The patient presented with agitation, guardedness, and impaired cognition, with a history of cardiac comorbidities necessitating multidisciplinary care.
• His decompensation was linked to noncompliance, poor provider communication, and handoff errors within the healthcare system.

Findings:

• The patient met criteria for treatment-resistant BPD I with mania.
• Neuroleptic treatment was complicated by cardiac comorbidities, pacemaker indications, and the patient's lack of treatment adherence insight.
• The complex admission course was influenced by at-risk demographics and healthcare system deficiencies, particularly relevant in resource-limited facilities.

Implications:

• This case underscores the need for integrated communication strategies for patients with delusional symptoms in mania.
• Individual and institutional strategies are essential to mitigate systematic errors in managing complex psychiatric cases.
• Addressing healthcare system shortcomings is vital for improving outcomes in patients with treatment-resistant BPD I, especially in underserved areas.