A 28-year-old man is brought to the emergency department by his family. Over the past 5 days he has slept only 2 hours per night, spent his savings on an elaborate business scheme, speaks so rapidly that he is difficult to interrupt, and believes he has been specially chosen to lead a new world religion. He has no prior psychiatric history and takes no medications. His urine toxicology screen is negative. What is the minimum duration of symptoms required to diagnose a manic episode?
- A 7 days ✓
- B 2 days
- C 4 days
- D 14 days
Correct answer: A. 7 days
Explanation
DSM-5-TR requires that a manic episode last at least 7 days (or any duration if hospitalization is required). The 4-day duration criterion applies to hypomanic episodes, which distinguishes bipolar I from bipolar II disorder. This patient's grandiosity, decreased need for sleep, pressured speech, and risky behavior for more than 5 days with functional impairment meets manic episode criteria regardless of the exact duration, but the threshold for diagnosis is 7 days.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.