Treatment Resistance in Bipolar Affective Disorder with Recurrent Mania Course - Role of Periventricular Leukomalacia.

A 34-year-old married female, educated up to grade 12, living as a homemaker in an urban area, presented to us for a clinical evaluation with a four-day history of manic symptoms along with auditory hallucinations and delusions of being pregnant. She had developed symptoms despite adherence to therapeutic doses of lithium, valproate, and quetiapine. She scored 27 on the Young Mania Rating Scale (YMRS) at the time of presentation. The evaluation included a detailed history, laboratory investigations, and neuroimaging of the brain.