case_images: PMC10804947_01
case_images: Neuroimaging Exams. (A) Brain MRI, FLAIR sequence; (B) Brain PET/CT with 18F-FDG. A decrease in glycidic metabolism is observed at the bilateral anterior temporal level.
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case_images: Glucose PET showed mild hypometabolism at the bilateral anterior temporal level, with preservation of metabolism in the rest of the cortical and subcortical structures (Figure 1).
case_images: Timeline of Pharmacological and Psychopathological Changes. (A) Psychopathological changes measured by MADRS and YMRS in depressive-like periods; (B) Psychopathological changes measured by MADRS and YMRS in mania-like periods. An initial improvement in both mania and depressive-like symptoms was observed during trazodone treatment, reaching a plateau in the response at month 9. Subsequently, the addition of lithium resulted in a greater improvement, and this response was sustained for up to 3 years of follow-up. MADRS, Montgomery-Asberg Depression Rating Scale; YMRS, Young Mania Rating Scale.
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case_images: Despite achieving blood lithium levels of 0.86 mmol/L in the subsequent month (see Figure 2, month 10), minimal effects on both mania and depression were observed (YMRS 25 to 24; MADRS 16 to 15), and the weekly cyclicity persisted. During the next visit (see Figure 2, month 11), following the recommendations for managing acute mania, we adjusted the dosage to 800 mg/day, resulting in a blood lithium level of 1.02 mmol/L.