Grandiosity symptoms, mania

Acute mania usually begins abruptly, and symptoms increase over several days. The severe stages may include bizarre behavior, hallucinations, and paranoid or grandiose delusions. There is marked impairment in functioning or the need for hospitalization. 

Bipolar affective (manic-depressive) disorder is a frequently diagnosed and very serious psychiatric disorder. Patients with cyclic attacks of mania have many symptoms of paranoid schizophrenia (grandiosity, bellicosity, paranoid thoughts, and overactivity). The gratifying response to lithium therapy of patients with bipolar disorder has made such diagnostic distinctions important. 

A 45-year-old woman had a long history of dysthymia and depression. She had taken many antidepressants, including tricyclics, SSRIs, amfebutamone, and venlafaxine. She had no history of mania or hypomania. She took sertraline 250 mg/day, with only a transient response, and mirtazapine 15 mg/day was added. Within 4 days she developed clear symptoms of hypomania, with euphoric mood, mild grandiosity, pressure of speech, increased energy, and a reduced need for sleep. Mirtazapine was withdrawn and sertraline continued within 3 days the hypomanic symptoms had remitted. The depressive disorder then re-emerged (3). 

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