A 26 year-old female is brought to your office by her husband because he is concerned about her symptoms. For over a year, she has been feeling less interested in things she usually enjoyed before, she is irritable ‘over little things’, she has trouble falling asleep, wakes up too early many nights, she is not eating much at the dinner table, she feels very tired ‘even after dishwashing’, when her husband gets intimate with her, she moves away, she is not able to concentrate or remember things, she expresses thoughts of emptiness and meaninglessness, and her husband is not comfortable to leave her alone at home. These symptoms dominated her life for over a year. But over the last two weeks, she is having outbursts of energy and feeling very active. She sounds so cheerful, optimistic and enthusiastic. She talks for hours without taking a break, moving from one subject to another subject. Her thoughts are difficult to follow. She is driving too fast and going on spending sprees. She sleeps only for a few minutes every night. She gets into fights with their neighbors over petty matters like where they keep their trash bags for removal by the waste disposal crew. She believes that she has ‘minds like an Einstein’ and passes judgments on things that are irrelevant to her. She is drinking too much alcohol ‘to calm herself’. She tells inappropriate jokes in front of children, dresses in inappropriate and colorful clothing; Three days ago, she told her husband that ‘Einstein’s soul is talking to her to explain a new theory of relativity’ to her. She argues that she is smart enough to win a Nobel Prize in Physics. In the morning, she looks too depressed and in the evening she looks like ‘she is over the clouds talking to Einstein’. She urinated in her pants and her husband had to take her to the emergency room. She was hospitalized for two days and was started on medication to calm her down. What is the most likely diagnosis in this patient?
