A 19-year-old college student is brought to student health services by her roommate, who is concerned about her recent behavior. The patient reports not needing sleep, feeling more creative than usual, and starting multiple art projects she cannot finish. She has felt this way for about 10 days. She also maxed out two credit cards shopping online. The patient denies hallucinations or suicidal ideation. She has no prior psychiatric history and does not take any medications. She does not use any drugs. Family history is notable for her father being hospitalized for “a manic episode” in his 30s. Vital signs are within normal limits. Physical examination reveals pressured speech, elevated mood, and distractibility.
B) Bipolar I disorder
Bipolar I disorder is diagnosed when a person has at least one manic episode, lasting at least 7 days (or any length of time if hospitalization is required), including 3 or more of the following criteria during the manic episode:
- Distractibility
- Insomnia
- Grandiosity (increased self-esteem)
- Flight of ideas or racing thoughts
- Activity/agitation (such as putting significantly more work into projects of increased sexual activity)
- Pressured or rapid speech
- Thoughtlessness (engaging in pleasurable activities with negative consequences)
This patient has had 10 days of mania and has at least three diagnostic criteria including insomnia, activity/agitation, distractibility, and pressured speech.
Answer choice A: Attention-deficit hyperactivity disorder, is incorrect. Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity that begins before age 12 and is evident across multiple settings. ADHD involves chronic inattention or hyperactivity, not episodic mood disturbances or decreased need for sleep.
Answer choice C: Bipolar II disorder, is incorrect. Bipolar II mood disorder characterized by at least one major depressive episode and one hypomanic episode (an abnormally and persistently elevated, expansive, or irritable mood that lasts at least 4 days and is not severe enough to cause marked impairment in social or occupational functioning), with no history of mania. This patient’s symptoms (e.g., impaired functioning, grandiosity, and psychomotor agitation) meet criteria for mania, not hypomania, thus indicating bipolar I disorder.
Answer choice D: Cyclothymic disorder, is incorrect. Cyclothymic disorder, is a chronic mood disturbance with periods of hypomanic and depressive symptoms not meeting full criteria for mania or major depression, lasting ≥2 years. The patient’s symptoms meet full criteria for mania and are too severe and discrete to be consistent with cyclothymia.
Answer choice E: Schizophrenia, is incorrect. Schizophrenia is a psychotic disorder characterized by delusions, hallucinations, disorganized speech, disorganized behavior, and/or negative symptoms for ≥6 months. The patient does not have psychosis or negative symptoms and exhibits prominent mood symptoms, which are central to bipolar disorder, not schizophrenia.
Key Learning Point
Bipolar I disorder is diagnosed by the presence of a manic episode (elevated or irritable mood and increased energy) lasting at least 7 days, with ≥3 associated symptoms including distractibility, insomnia, grandiosity, flight of ideas or racing thoughts, activity/agitation, pressured or rapid speech, and thoughtlessness.
