A 35-year-old man with grandiose ideas and disinhibition

Case scenario

A 35-year-old university academic reluctantly attended the surgery with his wife who was very concerned about his recent behaviour. She said that following a period of intense stress and overwork, he had become particularly ‘revved up’ over the last few weeks and was full of grandiose ideas and a general disinhibition. This was quite different from his usual calm and controlled demeanour and she felt she could not ‘connect’ with him. He strongly denied any problem and did not appear to have psychotic symptoms at the consultation, but had a history of a brief, treated depression in his early 20s. How should this be managed?