Severe pressure ulcer following an acute depressive episode in a patient with spinal cord injury

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Alvin Ip
Brad E. Dicianno


spinal cord injury, depression, pressure ulcer, bipolar disorder, medication adherence


Study design: Case report.

Objective: To present a case of a patient with spinal cord injury (SCI) and untreated bipolar disorder presenting with severe pressure ulcer following an acute depressive episode.

Setting: Outpatient assistive technology clinic in the United States.

Results: A 39-year-old community dwelling man with significant medical history of incomplete cervical SCI, spasticity, depression, and bipolar I disorder presented with the chief complaint of a need for mobility device evaluation. Only upon screening did the patient divulge that he had developed wounds on his hips. Additional history revealed that he had discontinued his medication for bipolar disorder, became depressed, and spent significant time lying in bed. On physical examination, a Stage IV 1x1x2 cm wound was noted over the left greater trochanter with exposed bone, active drainage of purulent material, and surrounding erythema. The patient was sent to the Emergency Department for wound treatment. He was seen by plastic surgery and surgical debridement was required.

Conclusion: In this particular case, it appears that the development of a severe pressure ulcer was caused by an acute depressive episode resulting from non-adherence to medication for bipolar disorder. Adding to the limited literature available on the topic, this case report sheds light on the possible relationship between depression and pressure ulcers in people with SCI. Further prospective and longitudinal studies on depression and pressure ulcers are needed to determine if a causal relationship exists. Routine care should include screening for concurrent psychiatric conditions and wounds in people with SCI.