Clinical and functional outcome in a subject with bipolar disorder and severe white matter hyperintensities

Background and Objectives: Neuroimaging studies have found higher rates of white matter hyperintensities (WMHs) in patients with bipolar disorder (BD) of all ages, although whether BD is associated with increased rates of WMHs independently from age and cerebrovascular risk factors is still matter of debate. The outcome of BD associated with severe WMHs is generally poor, but several authors have suggested that some factors could have a protective role in BD. The aim of the present study was to report the two-year follow-up of a woman with BD type I and severe WMH/PWMH lesions who was taking high concentrations of vitamin-D in her nutrition, as well as taking lithium and haloperidol as treatment. Case presentation: A 76-year-old woman was hospitalized for a mixed state BD. She had severe WMHs. She took lithium and haloperidol during the hospitalization and was euthymic at discharge as well as after two-years of follow-up. Her nutrition had a high concentration of Vitamin-D. Unfortunately, it was not possible to give her a second MRI. Conclusions: Although there was probable persistence of WMHs, the patient improved in both mood and quality of life. The possible protective effect of lithium and Vitamin-D is discussed. Received: 12 January 2010 Revised: 5 August 2010 Accepted: 14 September 2010 Short report 42 GIANLUCA SERAFINI ET AL. Background and objectives Neuroimaging studies have found higher rates of WMHs in patients of all ages with bipolar disorder (BD), most frequently localized in the frontal lobes and the frontal/parietal junction1. WMHs may indicate astrogliosis, demyelination and loss of axons and may be relatively more common in older patients with BD, reflecting an interaction of the disease with processes of normal aging. However, WMHs are also associated with several pathological conditions among older individuals2. As a result of this, the meaning of these lesions in BD is still unclear. Although there have been inconsistent results in the research on this issue, WMHs are considered to be negative prognostic factors, associated with treatment resistance, increased hospitalization rates, cognitive impairment and increased suicide risk in individuals with BD3,4. However, several other factors may play a protective role in BD. Tsai et al.5 reported that psychiatric treatment, including medication with antipsychotics or lithium, could be a protective factor against early natural death. Here, we present the case of a 76year-old woman who had had a BD for twenty-one years and had, in addition, severe WMH/PWMH lesions, who was admitted to our psychiatric hospital for a mixed state. The patient gave written consent before being included in the study.