Short term psychotherapy for the soldier in crisis following estimation for military duty
Gordana Dedić, Slaviša Djurdjevic
European Psychiatry February 17, 2007 DOI: 10.1016/j.eurpsy.2007.01.684 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A patient receiving ketamine for post-operative pain with no previously documented personal or family history of bipolar disorder |
| Interventions | Ketamine olanzapine lorazepam |
| Key findings | The authors report a possible ketamine-induced manic episode in a patient without prior bipolar disorder, with symptoms beginning within hours of infusion and culminating in mania by day 4. They argue this case suggests ketamine may induce mania in susceptible individuals, though they state it remains unclear whether it can do so. |
Abstract
Abstract Ketamine is an N-methyl-D-aspartate (NMDA) antagonist that has become increasingly recognized and utilized in the treatment of post-operative pain as a way to reduce opioid use. Overall ketamine is generally well tolerated, however it is associated with transient hypertension and neurologic "emergence phenomena" manifesting as dream-like states, irrational behavior, and delirium. From a psychiatric perspective, ketamine is known to cause mania in animal models, but evidence in humans is lacking. This report adds a fourth case of possible ketamine-induced mania to the literature, however this is the first case report of mania in a patient with no previously documented family or personal history of Bipolar Disorder. Decreased need for sleep occurred within hours of the initiation of the ketamine infusion and the symptoms of mania progressed throughout the next 3 days culminating on day 4 of ketamine therapy in a full manic episode. Well-known, post-anesthetic "emergence phenomena" after ketamine use differs from our case in that patients are generally somnolent, whereas our patient developed a manic state which took weeks to resolve with olanzapine and lorazepam treatment. This patient was off treatment and symptom free for more than a year before developing a second manic episode and subsequently being diagnosed with Bipolar Disorder. As ketamine is being increasingly used in psychiatric and non psychiatric populations, all providers should be aware of the possibility of an affective switch with the use of ketamine. It is unclear if ketamine can induce mania in susceptible individuals, though this case suggests that it may.