As an outstanding philosopher Nietzsche poses the question whether his creativeness persisted in spite of his deteriorating disease or appeared, among other features, as a consequence of his illness. A thorough psychopathological understanding of his last lucid year is attempted. He had an exaggerated self-esteem and grandiose sense of confidence and achievements. But his lack of insight did not lead him to engage in activities that could harm himself or his loved ones. Between January 1888 and until his ultimate deterioration in January 1889, Nietzsche was exceedingly productive. During this period, polar changes along with moderately overlapping periods appeared.