The recurrence of mania: environmental factors and medical treatment

Three patients experienced recurrent manic episodes while taking lithium at levels that previously had been effective. In each case, the patient's decompensation followed a life stress. These stresses, which had a striking similarity, involved conflictual situations in which the patient felt impelled to pursue activities contrary to his or her own interests and aspirations. The activities, often involving the patient's family, seemed impossible to avoid. These clinical examples, together with several reports from the literature, suggest that pharmacological, psychodynamic, and situational forces may need to be considered together to allow more accurate conceptualization and to prevent recurrence of mania.