Dual diagnosis patient: A therapeutic challenge

Objective: To analyze the case of a patient with bipolar disorder and substance use disorder. Material and methods: We evaluate the case of a 50-year-old woman with a diagnosis of bipolar disorder type II and a history of emotional instability from adolescence, who presented benzodiazepine dependence and abuse of analgesics in context of migraine headaches. Results: Detoxification process was started by changing the short half-life benzodiazepines to long half-life ones. Thereafter, the patient began a slow, gradual reduction in the use. During the process, the patient presented with various categories of affective destabilization of mixed dominance, which made it necessary to reduce the pattern of antidepressant and delay a greater drop in the standard benzodiazepines. Decrease of the analgesic dose was postponed and the patient was included in the outpatient dual diagnosis program. Conclusions: Bipolar relapses can hinder the process of detoxification and rehabilitation, which is a common problem in individual dual patients. Benzodiazepines and analgesics dependence or abuse can mask or modify typical manic symptoms or depressive episodes that the patient might have in the natural history of bipolar disorder. Dual diagnosis means a higher frequency of joint symptoms and a higher predisposition for switching to mania state with antidepressants than in non-dual bipolar patients. Patients with bipolar dual diagnosis must be evaluated and treated with great caution due to the difficulties that their management usually entails.