The clinical practice and available literature attest the presence of affective symptoms in psychosis and affective disorders with psychotic elements, allowing their conceptualization as entities of the same nosologic spectrum.

The description of a clinical picture that is part of the aforementioned pathology, installed under a treatment that has indication in the spectrum, which leads to supporting different pathophysiological mechanisms of those pathologies.

Presentation of an atypical onset of a manic episode in adolescence.

At the age of 14, a male adolescent had an acute psychotic episode, in complete remission after three months of treatment with risperidone. The antipsychotic treatment continued for seven months, when the adolescent had a decompensation consisting in a manic episode.

Considering the mode of onset of the manic episode, we have assumed a lack of compliance with the antipsychotic medication. The mother denies this possibility. We have continued the treatment with risperidone, which had no effect over the manic clinical picture, and we added valproic acid, failing to alleviate the symptoms. The clinical picture improved, with complete remission, under treatment with aripiprazole and valproic acid. After a month in which he refused to take the medication, the patient had another decompensation in the form of a manic episode with psychotic symptoms. This time we have decided to start long-acting injectable antipsychotic medication.

Through this case study, the authors wish to bring into notice the surprises that the clinical practice still offers and the necessity to research the underlining pathophysiological aspects of the disorder.

The authors have not supplied their declaration of competing interest.