title: Case report of a patient with bipolar disorder - migraines and epilepsy.
abstract: Bipolar disorder; migraines and epilepsy are three prevalent conditions, of which little is understood about their pathophysiological processes. Co-morbidities often present between two of these conditions, but it is uncommon for all three to co-exist in a patient. Here, we present a middle-aged gentleman, seen in the outpatient department of a district general hospital in England, who suffers from severe effects of all three disorders, with no other medical history. Clinical difficulties have arisen in the diagnosis and treatment of his bipolar disorder. Management of his depressive episodes with simple selective serotonin reuptake inhibitors and mood stabilisers were either ineffective, or precipitated complicating adverse effects. Persistent use of citalopram is likely to have triggered bipolar disorder, whilst quetiapine induced seizures. The clinical problems presented question the possibility that bipolar disorder; migraines and epilepsy may fall on the same spectrum of disorders. This could contribute towards the complexities in treating his conditions. Further insight into their link and interactions would facilitate diagnoses of these conditions, as well as improve treatment strategies when they are presented co-morbidly.
authors.affiliation: Clinical School, University of Cambridge, Cambridge, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Zhang
authors.forename: Mark
authors.initials: M
authors.lastname: Agius
authors.forename: Rashid
authors.initials: R
authors.lastname: Zaman
mesh_terms: D000328:Adult; D000339:Affect; D000786:Anger; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004829:Epilepsy, Generalized / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000139:chemically induced / Q000175:diagnosis*; D000069348:Quetiapine Fumarate; D014754:Violence
chemical_list: D000927:Anticonvulsants; D018687:Antidepressive Agents, Second-Generation; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D015283:Citalopram; D000069348:Quetiapine Fumarate