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.Abstract Teaser