Mania, crime and the insanity defense: a case report.

A case has been presented of a young manic depressive man whose first contact with a mental health professional was in connection with a criminal act performed during a manic episode. Information that is often not available or inadequate, especially a comprehensive family history, enabled the author to infer the presence of the illness at the time of the crime. An extended follow-up allowed the diagnosis to be confirmed, treatment to be instituted and reasonable certainty to be attained that the crimes occurred only as a manifestation of or in conjunction with the active phase of the illness. The obstacles to accurate diagnosis in such cases and their appropriate management are discussed in hopes of heightening the awareness of readers to the possibilities of such unsuspected cases in their midst.