An intercepted communique

To: [Redacted]
From: [Redacted]
RE: Psychological Eval 2 of asset "Sparky"
Attachments: Interview with aunt 1, Interview with chef Stephen, Interview with aunt 2, transcripts of meetings 1-17, bill for services, settlement agreement for damages, photos of damage to office.

Dear Sir,
After meeting with Sparky for the 17th time, I'm afraid my assessment stands. What you call megalomania is a difficult enough condition to treat through pharmaceutical therapy without the added bonus of the patient really being the smartest person in the room or being genuinely rich. It's far easier to treat those as delusions when the patient does not show up wearing a $14,000 suit. I have to agree with Drs. Flaumel, Jefferies and McIntosh that the patient does exhibit all of the signs of a nascent case of narcissistic personality disorder, and this is not something that we can treat with a pill or with the types of therapy that you derided as "huggy stuff." This is indeed serious, and the patient should be strictly monitored.
In addition, what you, chef Stephen, her maternal aunt and Sparky herself all describe as her "jumpy periods" and "angry moods" show all the earmarks of bipolar disorder, and while most people do fine on pharmaceuticals, the combination of narcissistic personality disorder and bipolar disorder is not something to be ignored.
Based on the types of episodes, I would call this a case of cyclothymia, as the patient seems to be more limited in the spectrum of episodes, tending to range from mild self-destructive behaviors when "down" to complete obliviousness to others when up. When describing the "suicidal situation" which you forbade her to discuss in detail, she seems to indicate an absolute conviction that the actions which led to her sickness were not suicidal, just careless and risky. Since you both claim that I do not possess a high enough security clearance to have the details of that event, I am severely hampered in my ability to understand it, but I really do not think it was a suicide attempt.
Cyclothymia is very treatable with the right pharmaceutical products, but it very rarely occurs in only one member of a family. I would suspect others with bipolar spectrum disorders in her family, and the maternal aunt seems to agree this is not the first time you have dealt with this in her family.
My only suggestion, other than pharmacological interventions and the prior suggestion to make her feel invested in your enterprise, is to handle her the same way you handled the other "manic depressive megalomaniac" in your service.
Lastly, I really don't think she is likely to turn from a "friendly" to an "enemy" without warning, but I would caution you that with this sort of narcissism, we tend to see patients that keep track of every little slight against them. Making her feel valued and loved might help to assuage some slights that you aren't even aware of, but she's smart enough to pick out that you're doing it for ingenuine reasons.
Last time, I offered our facility if a permanent placement was in order, but based on the damage to the office after I asked about her father's family, I really don't think we can be of assistance in that arena.
Yours,
DK