Case presentation.
Presenting symptoms. A 33-year-old
Russian man was admitted to a narcological
hospital complaining about the urge to use
the “skorost” synthetic stimulants, along with
mood swings, irritability and poor appetite.
The patient was a graduate psychologist that
had been unemployed for the last 6 months.
He was unmarried and lived with the parental
family as a dependent. Having a 6-year
history of psychiatric treatment for bipolar
and schizoaffective disorders, he was referred
to a rehabilitation program with symptoms of
stimulant addiction for the first time in his life.
The history of life and the course
of bipolar disorder. He had a premorbid
personality of being introverted and
melancholic, which has distinguished him
from his peers since school years. The patient
did not have history of any developmental
delays and concerns, brain injury, and did
not have a noteworthy trauma history. His
family was unremarkable for psychiatric
illness or substance use disorder. The patient
described his parents as dominating and
controlling, which, in his opinion, may have
limited his autonomy and assertiveness.
The first depressive episode with sadness,
loss of energy, feelings of hopelessness or
worthlessness, diminished interests and
pleasure, psychomotor retardation, declined
ability to think or concentrate was registered at
the age of twenty. It had lasted two weeks and
ceased after psychological support sessions
without any medication interventions. The
second depressive episode occurred after an
8-month intermission period without any
preceding mental distresses and somatic
abnormalities and was of a longer duration.
The intensity of the episode was characterized
with debilitated social interests, decreased
ability to concentrate, think, or make decisions,
and persistent anhedonia. Melancholic
features were not exhibited within the given
depression episode. An intense feeling of
dullness and internal emptiness substantially
marked the general self-perception and
accounted for progressive social isolation and
disadaptation. The 6-week episode was treated
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