Concurrent Presentation of Bipolar Affective Disorder and Recent Alcohol Cessation: Diagnostic Challenges in Resource Limited Setting

Abstract

Background: Bipolar Affective Disorder (BPAD) frequently coexists with Alcohol Use Disorder (AUD), creating diagnostic complexities, particularly when manic symptoms occur close to alcohol cessation. Accurate differentiation between primary mania and substance induced symptoms is critical for appropriate management.
Case Presentation: We describe a male in his early 30s with a two week history of elevated mood, irritability, reduced need for sleep, increased goal directed activity, and psychotic features, occurring shortly after abrupt cessation of chronic alcohol use. Although the patient initially reported stopping alcohol 3 months prior, collateral history revealed continued use until days before presentation. A previous untreated manic episode three years earlier strongly suggested primary BPAD. Diagnostic evaluation using DSM-5-TR criteria and the Mini International Neuropsychiatric Interview (MINI) supported a diagnosis of BPAD, current manic episode with psychotic features.
Management and Outcome: Treatment comprised carbamazepine, chlorpromazine, and a short diazepam course for anxiolysis. Psychoeducation and motivational interviewing addressed both the mood episode and AUD. The patient achieved full symptomatic remission and remained abstinent on follow-up.
Conclusion: This case emphasizes the importance of longitudinal psychiatric history, collateral information, and standardized diagnostic tools in distinguishing primary BPAD from alcohol related presentations in low resource settings.