Case 17: A young man with a plan to stop global warming
A 22-year-old man who for three weeks has hardly slept, drinks heavily, spends and gambles freely, and says he has a project to stop global warming.
- 2 min read
- Checked 01 Nov 2026
The case
For the past three weeks a 22-year-old man has been far more active than usual. He does not sleep at night, drinks a great deal and spends large sums on presents and gambling. He talks fast, and at times his train of thought is hard to follow. He says he can handle many things at once, that his mission is to make the world a better place, and that he has written a project to stop global warming. When anyone argues with him he becomes irritable and rude.
Summary
Diagnosis
Mania with psychotic symptoms, a manic episode of bipolar disorder.
What points to it
- More energy and less need for sleep, for three weeks: longer than the one week ICD-11 asks for.
- Racing thoughts and pressure of speech.
- Reckless spending, gambling and heavy drinking.
- A low threshold for frustration: irritable and rude when crossed. Irritability is as typical of mania as elation.
- Grandiose delusions, a mission to save the world, which fit his mood.
What else it could be
Alcohol and drugs, stimulants above all, can cause or worsen a manic state, so a drug screen and an alcohol history are needed. Hypomania lacks the psychotic features and the severe disruption.
Management
- Admission, to protect his health, money and relationships while his judgement is impaired.
- An antipsychotic for the acute mania, with lithium added if needed. A short course of a benzodiazepine can help with sleep and agitation, and covers alcohol withdrawal if he has been drinking heavily.
- Psychoeducation about bipolar disorder: early warning signs, regular sleep, and the harm alcohol does to the illness.
- Long-term prevention of relapse with a mood stabiliser, lithium first. In the UK valproate is no longer started in anyone under 55, men included, unless two specialists agree nothing else will do, because of its risks to children conceived or carried during treatment.
Outlook
The episode usually settles with treatment, but bipolar disorder is lifelong and relapses are likely, more so with alcohol misuse and if he stops his medication.