A 33-year-old pregnant woman at 26 weeks gestation, who had a history of
bipolar mood disorder, type I, was admitted to the hospital for hypomania
and poorly controlled diabetes mellitus. The patient had had her first
episode of affective illness at age 28, after the birth of her second
child. After an initial postpartum depression, she had cycled into a manic
state. She had subsequently been hospitalized seven times for acute mania.
A combination of valproate and chlorpromazine had proven effective in
managing most of her manic episodes, while her two most severe episodes had
been successfully managed with bilateral ECT.