The Effects of Yoga on Bipolar Disorder: A Systematic Review

Bipolar disorder (BD) is a mood disorder characterized by severe mood swings and or periods of depression. This study examined the role that practicing yoga has on the symptoms of BD. One of the main goals was to identify if patients with BD believe that yoga is a viable treatment option. Six research databases were searched using the keywords "yoga" AND "therapy" AND "BD" AND "bipolar depression." Articles published in 2005 and later were included in the search. After duplicates were removed, and inclusion and exclusion criteria were applied, five articles were analyzed and included in this literature review. Results of this review indicate that yoga has been shown to be associated with both benefits and risks for the treatment of BD. Studies have shown that yoga might relieve some symptoms of BD and depression. However, due to the lack of research on the impact of yoga on BD and the small number of studies included in this review, results should be approached with caution. Overall, yoga was well-tolerated in the studies reviewed in this article. Yoga may relieve the symptoms of depression. Future research should analyze the long-term impact of yoga on bipolar depression. Yoga instructional standards should also be considered.

Ischemic Colitis Secondary to Olanzapine and Clonidine Use in a Patient With a History of Laxative Abuse

Ischemic colitis is the most common type of intestinal ischemia and is caused by an acute arterial occlusion, thrombosis, or hypoperfusion of the mesenteric vasculature. This case centers around a 39-year-old female with a past medical history significant for a 20-year history of stimulant laxative abuse, chronic constipation, bipolar disorder, and anxiety that presented with ischemic colitis following 21 days of obstipation. At the time of presentation, the patient was taking olanzapine 15 mg daily for the treatment of bipolar disorder and clonidine 0.2 mg three times daily for anxiety. Over the course of her hospitalization, the patient was found to have a high stool burden, including calcified stool, contributing to ischemic colitis. She was successfully treated with a clonidine taper, multiple enemas, and laxatives. Pharmacological agents that induce constipation have been shown to increase the risk of colonic ischemia by increasing intraluminal pressure in the colon. Atypical antipsychotics block peripheral anticholinergic and anti-serotonergic receptors, limit gastrointestinal muscle contractions, and delay intestinal transit.

A Rare Case of Complete Atrioventricular Block Induced by Lithium Toxicity: Impact of Drug Interactions With Telmisartan

Lithium is primarily associated with gastrointestinal and neurological side effects, while, to the best of our knowledge, cardiac toxicity is rarely reported. We present a unique case of lithium toxicity manifesting as a complete atrioventricular (AV) block, occurring without typical signs of lithium toxicity such as tremors, gastrointestinal disturbances, or altered mental status. A 55-year-old woman with bipolar disorder and hypertension presented with worsening mood lability and an increasing frequency of panic attacks. Lithium therapy was initiated to stabilize her mood and manage worsening psychiatric symptoms. However, while receiving treatment in the acute ward, she developed bradycardia with complete AV block, despite the absence of neurological symptoms or any reported discomfort. Elevated serum lithium levels strongly suggested lithium toxicity as the underlying cause. As lithium levels decreased, her heart rate normalized, and her sinus rhythm was restored. A review of her medication regimen identified the antihypertensive agent telmisartan as a potential contributor to lithium toxicity, which ultimately resulted in severe arrhythmia. Following her recovery, a detailed evaluation with a 24-hour Holter electrocardiogram (ECG) revealed no significant arrhythmias or pauses, further supporting the conclusion that the bradycardia was primarily due to the interaction between lithium and antihypertensive medications. This case emphasizes the importance of recognizing atypical presentations of lithium toxicity, particularly cardiac manifestations, and highlights the potential for drug interactions with antihypertensive agents. Clinicians should maintain vigilance and ensure close monitoring when co-prescribing these medications to mitigate associated risks.