(#71)Transient mania related to steroid use in male with underlying hyperthymic temperament

Abstract: Hyperthymic temperament is characterized by high energy, sociability, and resilience. It can be difficult to distinguish it from hypomania or bipolar spectrum disorders, particularly under acute stress or physiological disruption. We present a case of a 52-year-old male with no prior psychiatric history, brought in under an involuntary hold after being found near a school in tactical gear and multiple firearms, citing "civil preparedness" in response to a natural disaster and recent sociopolitical unrest. Psychiatric evaluation revealed expansive mood, overvalued ideas, poor insight, and hyperverbal speech, but no frank psychosis or suicidality. Medical workup noted recent high-dose prednisone use, systemic inflammation, and subclinical hyperthyroidism. The patient described lifelong hyperenergetic traits, minimal sleep needs, and goal-driven behavior, consistent with hyperthymic temperament. He declined psychotropic medications but improved with psychotherapy and psychosocial support. This case illustrates how hyperthymic traits, though typically adaptive, can become destabilizing under compounding stressors, and underrepresents the importance of temperament-informed assessment to avoid misdiagnosis and unnecessary pharmacologic intervention.

Short Description: This poster presents a case of hyperthymic temperament misidentified as a mood disorder under acute stress. A 52-year-old male exhibited expansive mood and goal-driven behavior following a disaster, with contributing factors including high-dose steroids and subclinical hyperthyroidism. Despite initial concern for bipolarity, his traits aligned with lifelong hyperthymia. He improved without medications. The case underscores the importance of temperament-informed assessment to prevent misdiagnosis and avoid unnecessary pharmacologic intervention in similarly complex presentations.

Name of Sponsoring Organization(s): HCA Orange park