[Case Report] The ward received a case of excitable manic patient, who showed high emotional reaction, excitement and talk a lot, high self-evaluation, thinking that she is a genius, there is nothing she can’t do, talking as if she is a multi-talented female expert, but when asked carefully, there will be many flaws, seriously exaggerating her ability, needing less sleep, needing only 2-3 hours of sleep per day, while being tireless during the day. Energetic, busy, tiger-headed, think they have a lot to do, simply too late to do, accelerated association, claim to have too many ideas, a mouth simply too late to use, talk incessantly. This is one of the most common psychiatric disorders in psychiatry, diagnosed as “mania”, and treated with lithium carbonate combined with MECT. 2 weeks later, the patient’s condition improved significantly, and he talked about what happened when he was admitted to the hospital, and the patient himself felt very strange, and was ready to go through the discharge procedure at 4 weeks, but what happened next made every doctor in the ward Every doctor in the ward had to contemplate. The night before discharge, the patient had a recurrence of the same symptoms as when he was admitted and was very agitated, destroying things impulsively! An urgent check of the blood lithium concentration was in the effective therapeutic range (0.92), ruling out the possibility of a missed dose of medication. The patient had a few episodes of hyperarousal in the past year, but the degree was mild and the family did not pay attention to it, but it was the first time that it was so severe! When asked about the patient’s menstruation when she was excited and talkative, the patient’s mother recalled that it seemed that the patient’s excitement and talkative episodes occurred 1-2 weeks before her menstruation. Therefore, the diagnosis of cyclic psychosis was revised, and the patient was treated with a combination of 8 tablets each time, 3 times a day, and MECT again, and after 1-2 weeks, her condition stabilized again. No recurrence of the disease was seen in the follow-up. Analysis of the case] In post hoc analysis, this was a typical periodic psychosis, but the admission diagnosis was mania. The reasons for the misdiagnosis may be: 1. the patient’s first episode with typical manic manifestations; 2. previous episodes, but the degree of clinical manifestations was mild and did not attract the family’s attention; 3. the medical history was not provided in detail. The characteristics of menstrual cycle psychosis are: sudden onset 2 weeks before menstruation; rapid remission at the onset or cleansing of menstruation; various clinical manifestations, mania is one of the most common symptoms, some cases may even be accompanied by mild impairment of consciousness; in the remission period, with full self-awareness, urgent demand for treatment and prevention of relapse; with rewriting symptoms. Treatment is divided into symptomatic treatment and allopathic treatment. Manic episodes are treated with antimanic treatment, depressive episodes with antidepressant treatment, etc. And the most important thing is that the disease needs allopathic treatment, which can take oral vinyl estradiol, Chinese medicine da ying tablets or intramuscular injection of progesterone, which has better effect. Some women show a series of abnormal signs before each menstrual period, including significant physical, psychological and behavioral changes. These changes begin 1 to 2 weeks before menstruation, worsen 2 to 3 days before menstruation, and after the onset of menstruation, the symptoms abruptly decrease or disappear spontaneously, which is true for each menstrual cycle and lasts for at least six months, and some are accompanied by abdominal pain, nausea, vomiting, thirst and other somatic discomfort, called premenstrual syndrome. Cyclic psychosis, on the other hand, is much more serious than this and requires more attention.