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Abstract
Aim: This case report will discuss the approach to bipolar depression in an adolescent female patient with the 1q21.1 microdeletion.
Case: A 17-year-old female patient was referred to our clinic in the year 2023 due to a suicide attempt by drug intake and treatment refusal. She had been operated on at the age of 5 due to a diagnosis of pilocytic astrocytoma. At the age of 10, she was diagnosed with epilepsy and mild mental retardation. Her phenotypical anomalies included long philtrum, deeply set eyes, and macrocephaly. Genetic examination and chromosomal analyses resulted in a diagnosis of 1q21.1 microdeletion in the same year. At the age of 14, she experienced a manic episode lasting approximately 3 weeks, followed by recurrent depressive episodes and suicide attempts, for which she was hospitalized in psychiatric services twice. For the last 1 month, she had been experiencing complaints of anhedonia, irritability, and self-harm thoughts, and she had attempted suicide by ingesting medication 2 weeks before her hospitalization. The patient was diagnosed with "Bipolar Disorder Type 1, Current Episode Depression". Valproic acid was preferred as the mood stabilizer due to the nephrogenic effects of lithium, and the dose was adjusted to 1250 mg/day. The treatment was adjusted to risperidone 3 mg/day, quetiapine 900 mg/day, and depot risperidone 25 mg/2 weeks. Cognitive Behavioral Therapy-based patient and family sessions were conducted to address depressive cognitions and suicidal behaviors.
Conclusions: Our adolescent case with identified 1q21.1 microdeletion is presented as noteworthy, as the patient was also diagnosed with bipolar disorder. In the approach to mood disorders comorbid with epilepsy, the mood-stabilizing antiepileptic drug valproic acid, as in our case, may be preferred.
