Bipolar disorder with multiple comorbidities of a 55-year-old female patient: A case report

Table 1 Treatment protocol

Drug class	Medication	Dosage regimen	Rationale
Mood stabilizer	Sodium valproate	500 mg → 1500 mg/day	Primary choice for mixed episodes; avoids thyroid interactions
Atypical antipsychotic	Quetiapine	100 mg → 600 mg/day	Guideline-recommended (CANMAT) for mixed features; favorable metabolic profile vs. Olanzapine
Comorbidity management	Felodipine	5 mg/day	BP < 140/90 mmHg

Dosage titration was performed based on clinical response and tolerability. CANMAT: Canadian Network for Mood and Anxiety Treatments.

Table 2 Clinical outcomes

Assessment timepoint	HAMD-17 score	YMRS score	Suicide risk (C-SSRS)	Cognitive function (MMSE)
Baseline	22	28	High	24/30
Week 4	12	15	Moderate	26/30
Week 8	6	8	Low	28/30
6-month follow-up	4	6	Very low	28/30

HAMD-17: Hamilton Depression Rating Scale-17 items; YMRS: Young Mania Rating Scale; C-SSRS: Columbia-Suicide Severity Rating Scale; MMSE: Mini-Mental State Examination.