After one of our chapter members was hospitalized for extreme psychosis with symptoms resistant to psychotropic medications, it was realized by providers that low potassium level was the causal factor for these symptoms. This condition is called hypokalemia and produced psychotic symptoms completely separate from their bipolar diagnosis.
Dr. Ellen Hong has a definitive article concerning the link between hypokalemia and mental health.
Hypokalemia and Psychosis: A Forgotten Association
A 41-year-old African American woman with a past diagnosis of schizoaffective disorder and medical history of hypertension and chronic obstructive pulmonary disease (COPD) was brought to the emergency department for auditory hallucinations and paranoid delusions. Upon initial evaluation, she was irritable and agitated and reported active suicidal ideation associated with voices accusing her of being a murderer. She had recently moved into her brother’s apartment due to financial hardship and was unemployed. Family history was notable for a brother with schizophrenia. The patient denied a history of illicit substance use. Medications included hydrochlorothiazide for hypertension and albuterol as needed for COPD. The patient had been maintained on clonazapam and paroxetine for depression for the last several years without recent medication adjustment but had run out of medications a week prior to admission. Routine laboratory tests on admission revealed a potassium level of 2.3 mEq/L and negative urine toxicology.