Recurrent Treatment Emergent Delirium in A Case Of Bipolar Disorder With Primary Adrenal Insufficiency- A Case Report

Abstract

Background: Addison’s disease (AD) is associated with a range of neuropsychiatric symptoms, including mood disorders. Treatment-emergent delirium in patients with AD and comorbid bipolar affective disorder (BPAD) is rare. Case Report: A 45-year-old male with a 25-year history of episodic psychiatric illness developed increased talkativeness, overfamiliarity, and decreased need for sleep after medication discontinuation. Upon readmission, he was treated with lithium, quetiapine, and sodium valproate, subsequently developing delirium and hyponatremia. Sodium valproate was discontinued, and low-dose antipsychotics were introduced alongside lithium adjustments.  He responded well, with delirium resolving and manic symptoms managed effectively. Discussion: This case underscores the need for careful monitoring of electrolyte levels in patients with AD on psychotropic medications to prevent treatment-emergent delirium.