Case 8: A teenager who says she can heal everyone
A 19-year-old woman, brought to the outpatient clinic by her parents, who has hardly slept for days and says she can heal everyone.
- 2 min read
- Checked 01 Nov 2026
The case
A 19-year-old woman is brought to the outpatient clinic by her parents. She has barely slept for several days. She says she has extraordinary extrasensory powers, that she can heal everyone and make them happy. She talks so fast that it is hard to follow her train of thought. She is heavily made up and keeps trying to touch the doctor, to "diagnose and heal him".
Summary
Diagnosis
Mania with psychotic symptoms (psychotic mania). A first manic episode is diagnosed in ICD-11 as bipolar type I disorder.
What points to it
- Almost no sleep for several days.
- Racing thoughts and pressure of speech, too fast to follow.
- Elevated mood: she wants to make everyone happy.
- A striking appearance and over-familiarity: heavy make-up, touching the doctor.
- Grandiose delusions of special powers, which make the mania psychotic. They fit her mood.
What else it could be
Drugs (stimulants, cannabis) and steroids can cause a manic picture, so a drug screen and a medication history are needed, with thyroid tests. Schizoaffective disorder comes in if the psychotic symptoms outlast the mood change.
Management
- Admission: her judgement is impaired, and her disinhibition puts her at risk, sexual risk included.
- An antipsychotic first line (haloperidol, olanzapine, quetiapine or risperidone), with lithium added if it is not enough. Stop any antidepressant.
- Psychoeducation for her and her parents about bipolar disorder: early warning signs, sleep, alcohol and drugs.
- Long-term prevention of relapse with a mood stabiliser, lithium first, with level, kidney and thyroid monitoring.
Outlook
The episode usually responds well to treatment, but bipolar disorder is lifelong and relapses are likely, especially if she stops her medication.