The first episode occurred when she was 15 years old, a year after her menarche. A week before her menses were expected, she began to have difficulty sleeping and became emotionally upset and irritable. She had palpitations and "hot flashes" in her face and extremities. When menstruation began, she suddenly started talking to herself in a rambling and incoherent way, saying, for example, "Make up mind, the sun in the West will down and the sun in the East will rise . . . you are one of my friends . . . ." She became aggressive, threw furniture around, and tore her clothes. Sometimes she laughed loudly and then abruptly began to cry. At night she was unable to fall asleep and jumped up and down on the bed. She was sexually seductive, grimaced, and ignored attempts to calm her down.