Monday, November 16, 2009


A 25 year old woman is brought in by her roommate because she's "acting weirdly." But the patient denies this. "I feel better than ever," she says. "I'm invincible, I'm awesome, I only need four hours of sleep each night, and that's not even counting the sex, and even though I'm not getting to my job on time, I have all these projects I'm working on, and I have to go shopping, and sure, my friends can't stand me, but they couldn't before anyway when I was all moody and mopey and dopey and down, but that's okay, now I'm happy just going to the gym and working out for 3 hours a day, and besides, this has happened to me once before, a couple years ago, when all of a sudden I decided to quit school and go on a road trip and see the world, and all my friends thought I was tripping, ha, isn't that a good pun? but really I've never taken any drugs or seen a doctor, I'm healthy like that, and ooh, that's shiny." She points at a plaque you won for diagnostic acumen.

Challenge: Making the right diagnosis is important because the rate of suicide attempts is 25-50% (15% die of suicide) in this condition...what is it?


Suheil said...

Bipolar disorder 1- Mania +/- Major Depressive Illness.. Mania characterised by - euohoria, flight of thoughts, talkativeness, insomnia/ hyperactivity, indulgence in sex (all present in this patient).
Also, history of past depressive illness (may be reliable in this patients case) from the patient herself.

tree said...

bipolar disorder

Craig Chen said...


This is bipolar disorder; type I involves mania and type II involves hypomania (abnormal mood elevation without serious impairment of function or need for hospitalization).

Source: UpToDate.