Background: Caesarean section in patients with bipolar disorder complicated by an active psychotic episode presents significant perioperative challenges. Successful management requires a multidisciplinary approach addressing obstetric, anaesthetic, and psychiatric concerns to ensure maternal and fetal safety. Case Report: A 35-year-old female (G2P1L1) at 37+2 weeks of gestation, with a history of previous lower segment caesarean section and bipolar disorder, was posted for elective LSCS with sterilisation. She was hemodynamically stable, with normal laboratory investigations, adequate jaw movement, and Mallampati grade II airway. The patient had been on multiple psychotropic medications and had remained symptom-free for two years. Discontinuation of all medications 24 hours prior to surgery precipitated an acute psychotic episode, during which she denied her pregnancy and refused the procedure. As she lacked decision-making capacity, informed assent was obtained from her husband. Psychiatric consultation was sought; however, the patient continued to refuse surgery. Intravenous access was secured using behavioural distraction, followed by sedation. The caesarean section was successfully performed under general anaesthesia, with limb restraints applied using boxer bandages to prevent self-injury. Conclusion: Anaesthetic management in patients with severe psychiatric illness requires careful consideration of mental status and potential interactions between psychotropic and anaesthetic agents. Close coordination among obstetricians, psychiatrists, and anaesthesiologists is essential for optimal maternal and neonatal outcomes.