ABSTRACT
Example Ian is a 29-year-old landscape gardener. Currently, he has increased activity levels, slight pressure of speech and reduced sleep requirement (4 hours).
There are no psychotic phenomena. He has 'renewed energy for life and selfconfidence', and after having been single for some years is dating two women. He says he 'looks great'. He has also started to feel very confident in his job, putting himself forward for a promotion. Ian has only had two obvious previous episodes of illness (both hypomanic). These resulted in him having to 'give up good jobs'. Prior to both previous episodes of hypomania, Ian had broken up with 'serious girlfriends'. Less than one month after each break-up he began to 'find work easier'. He needed less sleep and finally began to engage in risky behaviours such as driving his car at speed. When well he complies with medication. Currently Ian wants to come off lithium. When high, Ian just 'goes with the flow'. He takes his music system up to his room and gets 'high on "heavy metal" music'. He also stops his lithium. Being high has had a marked impact on Ian's life, although on recovering from previous episodes Ian generally copes well with life without apparent stigma for his illness or low self-esteem. He does not drink or use drugs.
