Case Study on Mania: Reclaiming Stability in a 32-Year-Old Entrepreneur
Patient Information:
- Age: 32
- Gender: Female
- Background: High-performing tech entrepreneur based in Mumbai. Described as having an almost excessive work ethic, great charisma, and unbelievable energy.
History or Cause:
Pooja (name changed for privacy) was always a go-getter, founding her tech start-up at age 27 and leading it through two successful rounds of funding. Her colleagues appreciated Pooja's creativity and dedication to work, but over time, her behaviour began to escalate.
In the 6 months before her diagnosis, Pooja's sleep decreased to 2 hours a night. New impulsive business deals with undefined risks appeared to be fine to sign off without team conversations, she made large personal purchases (a luxury car and unaffiliated real estate) and would interrupt meetings for large amounts of time for wild but disorganised ideas.
Friends and family let it go as "startup stress" and "eccentric genius." However, the extreme change occurred over a couple of months.
She spoke increasingly quickly, action was no longer restrained by rational lines of thought, she believed she was on a holy mission to fix technology and also developed paranoid theories that the investors were "out to get her".
The crescendo was signified when Pooja accused her co-founder of betrayal at a big meeting with investors, to a large audience of stakeholders present. It seemed clear Pooja needed help.
Diagnosis:
Pooja was hospitalised in a private psychiatric hospital in Mumbai as a result of a mental health emergency call made by her sister.
Diagnostic Process:
- Initial Assessment: Initial assessment by a psychiatrist in Mumbai and clinical psychologist with DSM-5 criteria.
- Clinical Interviews: Conducted clinical interviews of Pooja, her sister, her co-workers and her previous therapist.
- Observation Period: One week of inpatient observation.
- Tools Used: Young Mania Rating Scale (YMRS), Mood Disorder Questionnaire (MDQ) and cognitive-behavioural assessments.
Diagnosis:
- Primary: Bipolar I Disorder – Current Episode: Manic, Severe, with Psychotic Features.
- Secondary: Generalized Anxiety Disorder (GAD), likely exacerbated by being an entrepreneur and chronic stress.
Treatment:
Approach:
Considering the severity of her manic episode and the presence of psychosis, the treatment of Mania was conducted in a multi-disciplinary phase-based model, proceeding from medical stabilization to longer-term psychological therapy and lifestyle modification.
Program:
1. Initial Stabilization (Inpatient - 3 Weeks):
- Medications:
- Mood Stabilizer: Lithium carbonate (titrated to therapeutic range).
- Antipsychotic: Olanzapine for psychotic features.
- Anxiolytic: Lorazepam, low-dose, as needed for anxiety and sleep support.
- Mood Stabilizer: Lithium carbonate (titrated to therapeutic range).
- Antipsychotic: Olanzapine for psychotic features.
- Anxiolytic: Lorazepam, low-dose, as needed for anxiety and sleep support.
- Supportive Care:
- Routine vital signs monitoring and blood level monitoring for lithium levels.
- Nutritional support and hydration therapy.
- Daily schedule with fixed routines to normalise her circadian rhythm.
- Routine vital signs monitoring and blood level monitoring for lithium levels.
- Nutritional support and hydration therapy.
- Daily schedule with fixed routines to normalise her circadian rhythm.
- Mood Stabilizer: Lithium carbonate (titrated to therapeutic range).
- Antipsychotic: Olanzapine for psychotic features.
- Anxiolytic: Lorazepam, low-dose, as needed for anxiety and sleep support.
- Routine vital signs monitoring and blood level monitoring for lithium levels.
- Nutritional support and hydration therapy.
- Daily schedule with fixed routines to normalise her circadian rhythm.
2. Transition Phase (Weeks 4–8 – Partial Hospitalization Program):
Therapy:
- Cognitive-Behavioural Therapy (CBT): Clinical focus on insight building and restructuring of distorted thinking style.
- Psychoeducation: Weekly meetings to have expert education regarding Bipolar Disorder, signs of relapse, and stress management skills for Pooja and her family.
- Occupational Therapy: Helping her transition back into work-life schedules with structured goals.
- Mindfulness & DBT Techniques: To build up skills of emotional regulation and distress tolerance.
3. Maintenance Phase (Months 3–12 – Outpatient Care):
- Continued psychiatric follow-up and medication adjustments.
- Bi-weekly therapy sessions focused on long-term plans and self-monitoring.
- Pooja joined a peer-led Bipolar Support Group, which was very significant in helping her to feel less isolated.
Improvements/Recovery Timeline:
- Week 1–2: Pooja's acute symptoms (e.g., paranoia, disorganised speech) begin to fade, and her sleep cycle stabilises, with the help of medication.
- Week 3–4: Pooja exhibits insight into her predicament. She expresses confusion and guilt about what she has done in the past.
- Week 5–8: Pooja is becoming a participant in therapy; she learns to recognise her early warning signs. She initiates journaling and tracking her moods.
- Month 3: Pooja returns to part-time work, with a self-imposed structure of screen time (one hour maximum) plus a mandated minimum of eight hours of sleep.
- Month 6: Pooja functions with no recurring symptoms, and her relationships (particularly with her sister and co-founder) continue to improve.
- Month 12: Pooja gives a TED-inspired talk at the support group meeting, sharing her story and emphasising the need for mental health awareness, particularly in the startup culture.
Our Success:
Impact on Patient’s Life:
Pooja regained control of her mental health and, arguably more importantly, her own identity. Her recovery was not solely focused on going back to work; instead, it was about learning how to lead without self-destructing.
She developed a sustainable way of working, reorganised her company such that the structure would allow them to take mental health days, and began advocating for mental health awareness in Silicon Valley. Now she maintains her own personal “Stability Protocol”- it is a self-created toolkit that is inclusive of sleep hygiene, reflective journaling, routine exercise, and bi-monthly sessions with her psychiatrist in Navi Mumbai.
Family and Community:
Pooja's sister was in shock, and later described the recovery as “a resurrection” in which the family connection deepened and she felt like one of Pooja's strongest pillars of support.
At work, by being transparent about her diagnosis, she created a culture of psychological safety; many employees spoke out about what they had to deal with, and the company now feels that mental health coverage should be included in their benefits package.
The Final Thought:
This example of mania illustrates the potential devastation — and even recognition, treatment and management — a manic episode can create. Mania can look like many things — genius, ambition, extreme passion. But when partnered with clinical awareness, compassion, and an appropriate plan, recovery is possible, and recovery is transformed.
From collapse to chance, Pooja's story is a beacon of future understanding in the fog of ambiguity and misunderstanding in mental illness. Mania can roar like a storm, but it passes when anchored to the right resources - therapy, medication, and belonging.
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Jagruti Rehabilitation Centre is a leading facility specializing in mental health, dementia, and addiction recovery. The team of psychiatrists, psychologists, and caregivers is committed to empowering individuals on their journey to recovery.
