Bipolar affective disorder
Subhashish Nath
Author is Postgraduate Trainee of Psychiatry at Silchar Medical College Hospital, Silchar

Mr. PD, a 19 years old unmarried Hindu male, a Bachelor of Arts (B.A.) first year student residing in a rural locality in a middle class extended family was admitted in psychiatry ward with chief complaints of sudden onset excessive roaming about, excessive talking, irritability, unnecessary spending, making big claims and aggressive behaviour for one month. His symptoms were gradually increasing in intensity. He had a past episode of similar nature eight years back with full recovery on treatment in about two months. However the past episode was preceded and followed by a variable period of low mood. Family history revealed presence of bipolar disorder in one of his second degree relative. There was no history of any substance abuse. Mental status examination revealed increased psychomotor activity, partial cooperativeness, poorly established rapport, a high pitched speech with increased rate and quantity, an exalted mood, tangential flow of thought, a mood congruent implausible grandiose delusion with acting out behaviour and elaboration, complex second person auditory hallucination and pseudo-hallucination without acting out behaviour with impaired attention, concentration and abstract thinking and a level two insight. He was diagnosed as a case of bipolar affective disorder, current episode manic with psychotic symptoms (F31.2). He was treated with divalproex sodium 1000mg and lorazepam 2mg and showed considerable improvement in the target symptoms within seven days.


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