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These additions reflected her euphoria paroxetine 10 mg sale medicine lodge kansas, but also her lack of inhibition and poor judgement. When she recovered she regretted ruining new and expensive clothing (which she had purchased during a manic buying spree). A manic female went to an occupational therapy session and made a card for her doctor, which stated she was ready to leave hospital. The construction (different coloured papers and pieces of bright cloth) tended to contradict her written message. Irritability often emerges later in an episode of mania (perhaps in response to clinicians obstructing patient wishes), but it may also manifest as an early feature. An unsolicited letter from a woman with mania to a male member of the hospital staff. This staff member was not involved in the care of the patient, and they had not been introduced. Thus, the endearments at the beginning and end of the letter indicate disinhibition. The patient reports being unable to sleep at night (a common manic symptom). An additional important feature is that the patient is apologising for episodes of irritability: “I do hope you can forgive me for my terrible absolute fowl moods” and “my terrible tongue, I ask you to please forgive me”. Flight of ideas is common, occasionally with clanging or punning. Thought and behaviour may be chaotic and uncharacteristic for the individual. A middle aged woman who had been successful in business was admitted to hospital in a manic state. An intimate relationship had recently ended, and there was advice from relatives that her partner had left the relationship with an unjustifiably large amount of money. The patient demonstrated thought disorder, but was able to indicate that she had put money in her vagina. It was a in the form of a role, about the size of a cigarette. As the patient was manic it was not surprising that she had used various different brightly coloured bands. On the wrapping paper was written, “The hole in the Wall”. This term is used in some parts of the world to indicate an ATM, from which one obtains money.