Related Case Studies
Case Study of Mania: Restoring Stability in a 32-Year-Old Businessperson
Patient Information
Age: 32
Gender: Female
Background: Successful high-flying Mumbai tech entrepreneur. Described as possessing a pathological work ethic, fantastic charisma, and unreal energy.
History or Cause
Pooja (name changed) was always a doer, having founded her technology start-up firm at the age of 27 and having weathered two successful fundraising rounds. Pooja's work ethic and creativity were appreciated by her coworkers, but she grew more and more extreme in her actions in the years that followed.
During the 6 months before her diagnosis, Pooja's sleep dropped to 2 hours nightly. Spontaneous new business opportunities with uncertain risks were okay to authorise without squad consultation, she was purchasing large personal items (a high-end car and standalone property) and would finish meetings early for hours on end for odd but not-formulated ideas.
Friends and family wrote it off as "startup stress" and "eccentric genius." But the revolutionary change took a few months to materialise. She talked ever faster, action no longer controlled by sequences of rational thought, she felt that she was on a mission from God to fix technology and also started paranoid conspiracy theories that the investors were "out to get her.".
Crescendo was triggered when Pooja accused her co-founder of betrayal in a big investor meeting, before a gigantic crowd of stakeholders who were in attendance. It seemed clear that Pooja needed intervention.
Diagnosis
Pooja was taken to an off-campus psychiatric hospital in Mumbai after a mental state emergency call was made by her sister.
- Diagnostic Process
Initial Evaluation: First-time evaluation by a psychiatrist based in Mumbai and a clinical psychologist using DSM-5 criteria.
Clinical Interviews: Conducted clinical interviews with Pooja, her sister, coworkers and her previous therapist.
Observation Period: One week of inpatient observation.
Tools Utilised: Young Mania Rating Scale (YMRS), Mood Disorder Questionnaire (MDQ) and cognitive-behavioural tests.
- Diagnosis
Primary: Bipolar Disorder – Current Episode: Manic, Severe, with Psychotic Features.
Secondary: Generalised Anxiety Disorder (GAD), most probably worsened by being an entrepreneur and chronic stress.
Treatment
Since the manic episode and psychosis were severe, treatment of Mania was undertaken in a multi-disciplinary phase-based model, beginning with medical stabilisation and progressing to longer-term life change and psychological therapy.
Program:
1. Stabilisation Initial (Inpatient - 3 Weeks):
Medications:
Mood Stabiliser: Lithium carbonate (titrated to therapeutic level).
Antipsychotic: Olanzapine for psychotic symptoms.
Anxiolytic: Lorazepam, low-dose, prn for anxiety and sleep facilitation.
Supportive Care:
Routine monitoring of vital signs, monitoring of lithium levels by blood level.
Hydration therapy, nutritional therapy.
Routine day-to-day activities in her daily schedule to stabilise her circadian rhythm.
2. Transition Phase (Weeks 4–8 – Partial Hospitalisation Program):
Cognitive-Behavioural Therapy (CBT): Clinical focus on insight acquisition and distorted thought patterns.
Psychoeducation: Weekly ongoing sessions to obtain professional education regarding Bipolar Disorder, relapse warning signs, and stress management skills for Pooja and family members.
Occupational Therapy: Helping her settle into work-life routines with step-by-step goals.
Mindfulness & DBT Skills: To be taught emotional regulation and distress tolerance skills.
3. Maintenance Phase (Months 3–12 – Outpatient Treatment):
- Serial psychiatric follow-up and medication compliance.
- Bi-weekly sessions of long-term planning and self-monitoring.
- Pooja visited a peer-led Bipolar Support Group, and this was very significant in breaking down her feelings of isolation.
Improvements/Recovery Timeline:
Week 1–2: Pooja's acute symptoms (e.g., paranoia, disorganised speech) resolve, and her sleep pattern normalises, with the help of medication.
Week 3–4: Pooja expresses recognition of her condition. She remains perplexed and apologetic about her previous behaviours.
Week 5–8: Pooja is now an active therapy member; she is becoming aware of her warning signs. She begins journaling and mood monitoring.
Month 3: Pooja returns to part-time employment, with an internally imposed schedule of screen time (one hour at most) complemented by a legislatively required minimum of eight hours of sleep.
Month 6: Pooja functions with no recurring symptoms, and her interpersonal relationships (particularly with her co-founder and sister) are getting better.
Month 12: Pooja gives a TED-style talk during the support group session, sharing her experience and stressing the need for mental health awareness, particularly in the startup world.
Our Success
Pooja regained control of her mind and, more importantly, of herself. Recovery was not about going back to work; it was about learning how to lead without ruining herself.
She built a sustainable work culture, redesigned her company so the infrastructure could support them having mental health days, and began working to promote mental health in Silicon Valley. She still maintains her own "Stability Protocol"- it is her own customised set of tools that includes sleep hygiene, reflective journaling, regular exercise, and bi-monthly sessions with her Navi Mumbai psychiatrist.
Family and Neighbourhood:
Pooja's sister had been in shock, and later said the recovery was "a resurrection" in which the family bond grew closer, and she felt like one of Pooja's strongest pillars of strength.
In the workplace, by being open about her diagnosis, she created a culture of psychological safety; many employees griped about what they had to go through, and the corporation now feels that mental health coverage is something they need to include in their benefits package.
The Final Thought
This mania vignette illustrates the potential devastation and even identification, treatment, and management that a manic episode can cause. Mania may manifest itself as so many things: brilliance, motivation, boundless energy. But with clinical acumen, compassion, and the appropriate plan, recovery is possible, and recovery is transformed.
From disintegration to possibility, Pooja's story is a beacon of future understanding through the fog of mistaking and misunderstanding in mental illness. Mania can rage like a typhoon, but it ebbs when based on the proper supports - therapy, medication, and human connection.
Dr. Amar Shinde, founder of Jagruti Rehab, is a renowned psychiatrist in India with over two decades of experience in mental health, addiction recovery, and neuropsychiatry, dedicated to holistic, compassionate patient care.