Miss B. 22-year-old female, studied up to 10th std., a semi-skilled worker and unmarried. There was a family history of bipolar illness in the patient's father. Both her parents died when she was 6-year-old, and she was raised by her grandparents. The patient had an early onset of BPAD-mixed affective state precipitated by her transition from school to college. Her symptoms then involved irritability, anger outbursts directed at family members, over-cheerfulness, and increased social interaction with strangers. Along with these symptoms, she also experienced periods of sad mood accompanied by social withdrawal and reduced psychomotor activity. Her behavior would oscillate from being cheerful to very dull, grooming excessively or neglecting self-care, overeating or poor appetite, and sleeping excessively to having insomnia. These symptoms continued for about 8 months after which she was treated with pharmacotherapy and showed significant improvement. However, a year later, she again presented to NIMHANS with the complaints of sad mood, reduced interest in work, easy fatigability, overactivity, over-cheerfulness, and over-talkativeness. The management of her symptoms again consisted of pharmacotherapy, with which her symptoms improved for next almost 4 years. However, she continued complaining of easy fatigability, lack of motivation to go to work, frequent headaches and occasional irritability and anger outbursts. She was referred for psychotherapy for the management of these residual symptoms.