Delirium in Bipolar Disorder as a Triggering Factor to Cognitive Decline: A Case Report and Neuroprogression Insight
DOI:
https://doi.org/10.61194/psychology.v3i4.784Keywords:
Bipolar Disorder, Delirium, Mild Cognitive Impairment, Metabolic Syndrome, Neuroprogression, Multidisciplinary ManagementAbstract
Bipolar disorder is a major contributor to global disability, affecting not only mood regulation but also cognitive function, and its impact is often exacerbated by metabolic comorbidities such as type 2 diabetes mellitus, hypertension, and dyslipidemia. These comorbid conditions can lead to poorer clinical outcomes and increase the risk of neuropsychiatric complications such as delirium and cognitive impairment, which are frequently overlooked in clinical practice. This article aims to describe and analyze the case of a 31-year-old male with a history of bipolar disorder who presented with a hyperglycemic crisis and pneumonia, followed by the onset of acute delirium and subsequent cognitive decline. Through a descriptive clinical approach, the patient’s medical and psychiatric history, laboratory findings, and treatment course are reviewed to explore the complex interaction between mood disorders and metabolic dysfunction. The analysis reveals a strong link between metabolic dysregulation and worsening neuropsychiatric outcomes. This case underscores the importance of early detection and an integrated, multidisciplinary management approach to prevent long-term cognitive deterioration in patients with psychiatric disorders accompanied by metabolic conditions, offering important implications for future clinical practice.
References
Bertollo, A. G., Puntel, C. F., Silva, B. V, Martins, M., Bagatini, M. D., & Ignácio, Z. M. (2025). Neurobiological Relationships Between Neurodevelopmental Disorders and Mood Disorders. Brain Sciences, 15(3), 307. https://doi.org/10.3390/brainsci15030307
Besterman, A. D., Adams, D. J., Wong, N. R., Schneider, B. N., Mehta, S., DiStefano, C., Wilson, R. B., Martinez-Agosto, J. A., & Jeste, S. S. (2024). Genomics-informed neuropsychiatric care for neurodevelopmental disorders: Results from a multidisciplinary clinic. Anesthesia & Analgesia, 27, 101333. https://doi.org/10.1016/j.gim.2024.101333
Bishir, M., Bhat, A., Essa, M. M., Ekpo, O., Ihunwo, A. O., Veeraraghavan, V. P., Mohan, S. K., Mahalakshmi, A. M., Ray, B., Tuladhar, S., Chang, S., Chidambaram, S. B., Sakharkar, M. K., Guillemin, G. J., Qoronfleh, M. W., & Ojcius, D. M. (2020). Sleep Deprivation and Neurological Disorders. BioMed Research International, 2020(1). https://doi.org/10.1155/2020/5764017
Cai, H., Dong, J., Mei, L., Feng, G., Li, L., Wang, G., & Yan, H. (2024). Functional and structural abnormalities of the speech disorders: A multimodal activation likelihood estimation meta-analysis. Cerebral Cortex, 34, 75. https://doi.org/10.1093/cercor/bhae075
Carloni, S., & Rescigno, M. (2023). The gut-brain vascular axis in neuroinflammation. Seminars in Immunology, 69, 101802. https://doi.org/10.1016/j.smim.2023.101802
Chang, H., Hoshina, N., Zhang, C., Ma, Y., Cao, H., Wang, Y., Wu, D., Bergen, S. E., Landén, M., & Hultman, C. M. (2018). The protocadherin 17 gene affects cognition, personality, amygdala structure and function, synapse development and risk of major mood disorders. Molecular Psychiatry, 23(2), 400–412. https://doi.org/10.1038/mp.2016.220
Cryan, J. F., O’Riordan, K. J., Cowan, C. S. M., Sandhu, K. V, Bastiaanssen, T. F. S., Boehme, M., & Dinan, T. G. (2019). The microbiota-gut-brain axis. Physiological Reviews, 99(4), 1877–2013. https://doi.org/10.1152/physrev.00018.2018
Dalkner, N., Bengesser, S. A. , Birner, A. , Fellendorf, F. T. , Fleischmann, E. , Großschädl, K. , Lenger, M. , Maget, A. , Platzer, M. , Queissner, R. , Schönthaler, E. , Tmava-Berisha, A. , & Reininghaus, E. Z. (2021). Metabolic Syndrome Impairs Executive Function in Bipolar Disorder. Frontiers in Neuroscience, 15. https://doi.org/10.3389/fnins.2021.717824.
Dall, M., Fellinger, J., & Holzinger, D. (2022). The link between social communication and mental health from childhood to young adulthood: A systematic review. Frontiers in Psychiatry, 13, 944815. https://doi.org/10.3389/fpsyt.2022.944815
Dragasek, J., Minar, M., Valkovic, P., & Pallayova, M. (2023). Factors associated with psychiatric and physical comorbidities in bipolar disorder: a nationwide multicenter cross-sectional observational study. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1208551
G.B.D. (2022). Mental Disorders Collaborators. The Lancet. Psychiatry, 9(2), 137–150. https://doi.org/10.1016/S2215-0366(21)00395-3
Gu, L., Sun, M., Li, R., Zhang, X., Tao, Y., Yuan, Y., Luo, X., & Xie, Z. (2022). Didymin Suppresses Microglia Pyroptosis and Neuroinflammation Through the Asc/Caspase-1/GSDMD Pathway Following Experimental Intracerebral Hemorrhage. Frontiers in Immunology, 13. https://doi.org/10.3389/fimmu.2022.810582
Haddad, P. M., Alabdulla, M., Latoo, J., & Iqbal, Y. (2021). Delirious mania in a patient with COVID-19 pneumonia. BMJ Case Reports, 14(11), 243816. https://doi.org/10.1136/bcr-2021-243816
Halvorsen, M., Mathiassen, B., Myrbakk, E., Brøndbo, P. H., Sætrum, A., Steinsvik, O. O., & Martinussen, M. (2019). Neurodevelopmental correlates of behavioural and emotional problems in a neuropaediatric sample. Research in Developmental Disabilities, 85, 217–228. https://doi.org/10.1016/j.ridd.2018.12.001
Hamamah, S., Aghazarian, A., Nazaryan, A., Hajnal, A., & Covasa, M. (2022). Role of microbiota-gut-brain axis in regulating dopaminergic signaling. Biomedicines, 10(2), 436. https://doi.org/10.3390/biomedicines10020436.
Huang, Y., Li, Y., Pan, H., & Han, L. (2023). Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide. Journal of Global Health, 13, 4160. https://doi.org/10.7189/jogh.13.04160
Krishnan, K., Miller, A. K., Reiter, K., & Bonner-Jackson, A. (2022). Neurocognitive Profiles in Patients With Persisting Cognitive Symptoms Associated With COVID-19. Archives of Clinical Neuropsychology, 37(4), 729–737. https://doi.org/10.1093/arclin/acac004
Liu, L., Ni, S.-Y., Yan, W., Lu, Q.-D., Zhao, Y.-M., Xu, Y.-Y., Mei, H., Shi, L., Yuan, K., Han, Y., Deng, J.-H., Sun, Y.-K., Meng, S.-Q., Jiang, Z.-D., Zeng, N., Que, J.-Y., Zheng, Y.-B., Yang, B.-N., Gong, Y.-M., & Lu, L. (2021). Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action. EClinicalMedicine, 40, 101111. https://doi.org/10.1016/j.eclinm.2021.101111
Longo, S., Rizza, S., & Federici, M. (2023). Microbiota-gut-brain axis: relationships among the vagus nerve, gut microbiota, obesity, and diabetes. Acta Diabetologica, 60(8), 1007–1017. https://doi.org/10.1007/s00592-023-02088-x
Mariano, A., Lorenzo, G., Jannini, T. B., Santini, R., Bertinelli, E., Siracusano, A., & Niolu, C. (2021). Medical Comorbidities in 181 Patients With Bipolar Disorder vs. Schizophrenia and Related Psychotic Disorders: Findings From a Single-Center, Retrospective Study From an Acute Inpatients Psychiatric Unit. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.702789
Nguyen, T. T., Eyler, L. T., & Jeste, D. V. (2020). Systemic inflammation and cognitive aging in schizophrenia and bipolar disorder: Link with white matter integrity. Science Advances, 6(6), 8555. https://doi.org/10.1126/sciadv.aba8555
Pan, X., Mota, S., & Zhang, B. (2020). Circadian Clock Regulation on Lipid Metabolism and Metabolic Diseases (pp. 53–66). https://doi.org/10.1007/978-981-15-6082-8_5
Poletti, S., Mazza, M. G., & Benedetti, F. (2024). Inflammatory mediators in major depression and bipolar disorder. Translational Psychiatry, 14, 247. https://doi.org/10.1038/s41398-024-02852-2
Rogers, J. P., Chesney, E., Oliver, D., Pollak, T. A., McGuire, P., Fusar-Poli, P., Zandi, M. S., Lewis, G., & David, A. S. (2020). Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. The Lancet Psychiatry, 7(7), 611–627. https://doi.org/10.1016/S2215-0366(20)30203-0
Safar, K., Vandewouw, M. M., Pang, E. W., Villa, K., Crosbie, J., Schachar, R., Iaboni, A., Georgiades, S., Nicolson, R., & Kelley, E. (2022). Shared and distinct patterns of functional connectivity to emotional faces in autism spectrum disorder and attention-deficit/hyperactivity disorder children. Frontiers in Psychology, 13, 826527. https://doi.org/10.3389/fpsyg.2022.826527.
Sasso, J. M., Ammar, R. M., Tenchov, R., Lemmel, S., Kelber, O., Grieswelle, M., & Zhou, Q. A. (2023). Gut Microbiome–Brain Alliance: A Landscape View into Mental and Gastrointestinal Health and Disorders. ACS Chemical Neuroscience, 14(10), 1717–1763. https://doi.org/10.1021/acschemneuro.3c00127
Schnorr, S. L., Khawandanah, J., Gloor, G. B., & Chahwan, R. (2022). The gut-brain axis in health and disease: A review of the evidence from microbiome studies in mood disorders. Microorganisms, 10(11), 2268. https://doi.org/10.3390/microorganisms10112268
Schou, L., Rosenvinge, F. S., Damsgaard, T. E., & Rostrup, E. (2023). Neuroinflammation, brain structure and cognitive function in bipolar disorder. Brain Sciences, 15(3), 307. https://doi.org/10.3390/brainsci15030307
Sesso, G., Cristofani, C., Berloffa, S., Cristofani, P., Fantozzi, P., Inguaggiato, E., Narzisi, A., Pfanner, C., Ricci, F., & Tacchi, A. (2020). Autism spectrum disorder and disruptive behavior disorders comorbidities delineate clinical phenotypes in attention-deficit hyperactivity disorder: Novel insights from the assessment of psychopathological and neuropsychological profiles. Journal of Clinical Medicine, 9(12), 3839.
Vargas-Soria, M., García-Alloza, M., & Corraliza-Gómez, M. (2023). Effects of diabetes on microglial physiology: a systematic review of in vitro, preclinical and clinical studies. Journal of Neuroinflammation, 20(1), 57. https://doi.org/10.1186/s12974-023-02740-x