Manic Stage

She’s a teacher, first came to us being depressed, presented with a complete negative outlook, lacking drives and interests, having crying episodes, and not being able to teach.

After few months of treatments, she recently called up and requested for a letter written to the ministry of education, to say that she’s recovered. During the phone call, she said she’s still regular with med, but now she has no more crying episodes, and her mood is good generally.

Coincidentally one day when she was in school and called up to check whether the report was ready, the school principal walked past her, and requested to speak to me. The principal asked whether the family has contacted us regarding the patient’s condition (negative). She said although patient is no longer crying and depressed now, she has been doing things completely out of order.

The headmistress said patient has organized a basketball competition completely by her own, without the school’s permission but under its name. She also brought a few of her students out for day trip, and only sent them home past midnight. When she meets someone new, she talks a lot, telling a lot of private details about herself. Sometimes she feels tired and will just sleep in the school storeroom. She also refused to go home after the basketball event, stayed at the court and fell asleep there at 3am when she was found by the family. She tries to spend all her time away from home, refusing to go home. She promises to anything and everything others ask her to do, and fail to keep her promises. Others can’t criticize anything about her, she thinks she’s perfect, best of the best, so whoever criticizing her, she becomes very argumentative and defensive, which is why she argued with and shouted at the principals.

The patient displayed some of the very typical symptoms of one who gets into manic phase, especially the part where they feel invincible, perfect, without weakness, and the power to keep going without needing to rest or sleep. One to add is shopping spree, a lot of them turns to spending money when they become manic, feeling like they are always short of something.

A lot of these  during treatment and recovery requires attention from the family or people around them, as the clinician may not always realize that patient has turned manic just within a 20 mins consultation – they may just seem happy, recovered from depression, instead of manic. And indeed, that’s part of some people’s personality. So the family should know where the base line is, and giving feedback to the clinician.

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