title: Hoarding Symptoms Respond to Treatment for Rapid Cycling Bipolar II Disorder.
abstract: Although some studies have reported a relationship between hoarding and bipolar disorder, we are unaware of any previous description of how they may interact with each other and how they should be managed appropriately. A 48-year-old male depressed patient with hoarding symptoms and obsessive-compulsive disorder (OCD) was diagnosed with bipolar II disorder after 2 hypomanic episodes. The patient was treated unsuccessfully with different high-dose serotonin reuptake inhibitors and atypical antipsychotics, maintaining a pattern of 6 to 8 discrete, but severe, depressive episodes each year, always in association with a drastic worsening of his OCD and hoarding symptoms. T.he patient did not improve until the dose of the serotonin reuptake inhibitor was decreased and a combination of lamotrigine and methylphenidate was initiated. On this treatment regimen, the patient did not show clinically significant levels of depression or hoarding or other OCD symptoms. This case suggests that, in some patients, (1) hoarding-related cognitions and behaviors may be a part of bipolar depression, (2) the episodic nature of rapid cycling bipolar II disorder may protect against the development of severe clutter, and (3) treatment focusing on bipolar depression (eg, lamotrigine plus methylphenidate) may result in an improvement of hoarding symptoms when these are present in patients with rapid cycling bipolar II disorder.
authors.affiliation: LAURITO, FONTENELLE: Programa de Pesquisa em Espectros Ansioso, Obsessivo e Compulsivo, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), and Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brasil FONTENELLE: School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Vic., Australia KAHN: Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Luana D
authors.initials: LD
authors.lastname: Laurito
authors.forename: Leonardo F
authors.initials: LF
authors.lastname: Fontenelle
authors.forename: David A
authors.initials: DA
authors.lastname: Kahn
mesh_terms: D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use; D000067836:Hoarding Disorder / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D014227:Triazines / Q000627:therapeutic use
chemical_list: D002121:Calcium Channel Blockers; D018765:Dopamine Uptake Inhibitors; D000077213:Lamotrigine; D008774:Methylphenidate; D011619:Psychotropic Drugs; D017367:Selective Serotonin Reuptake Inhibitors; D014227:Triazines