Communication and Handoff Errors Within Treatment-Resistant Bipolar I Disorder

Bipolar I disorder includes periods of acute mania, e.g., symptoms of risk-taking behavior and impulsivity, which may result in interpersonal conflict with long-term implications. Bipolar I disorder management may be complicated by disruptions in care, both by patients and healthcare systems. We present a case of a 69-year-old male who was involuntarily committed by his wife due to inappropriate sexual behavior and delusions secondary to mania. In the emergency department, the patient appeared agitated, guarded, and with impaired cognition. His medical history included cardiac comorbidities, requiring multidisciplinary involvement. We describe how our patient’s decompensation was contributed by a combination of noncompliance, lack of provider communication, and handoff errors. Our patient met the diagnostic criteria for treatment-resistant bipolar I disorder with mania, generalized anxiety disorder, and severe tobacco use disorder. His treatment with neuroleptics was complicated by cardiac comorbidities, indications for pacemakers, and his lack of understanding regarding the need for treatment. Our case describes a uniquely complicated admission course in part by our patient’s at-risk demographics and healthcare system shortcomings that may be more common in resource-limited facilities. We aim to integrate communication strategies for patients experiencing delusional symptoms, alongside individual and institutional strategies to mitigate systematic errors.