A 28 year old lady was admitted to the psychiatric ward after she had ran out of the house removing her clothes. She complained of feeling depressed but was speaking very fast. She did not let the resident doctor complete his questions. She was hyperactive, distractable and often confronted people on the ward. She complained about not being able to sleep and was low in mood despite being on an antidepressant. Which of the following is the most appropriate treatment for her condition?

In the scenario the young lady is presenting with disinhibition, irritability, pressure of speech, insomnia and increased energy levels. These symptoms are suggestive of a manic episode. However one would expect the mood to be 'high' in an episode of mania. In this scenario the lady has low mood. This means that the patient has a combination of manic and depressive symptoms at the same time. The likely diagnosis is Bipolar Affective Disorder (MDP), Mixed Affective State. The treatment is discontinuing antidepressant (as it worsens mania) and sta a mood stabilizers like Lithium, Sodium Valproate and Carbamazepine. Methylphenidate is used to treat ADHD. Typical Antipsychotics do not have mood stabilising effects, however can be used for rapid tranquillisation E.g. Haloperidol.