Which of the following is the hallmark feature that distinguishes Bipolar II disorder from Bipolar I?

• A Presence of mixed features during depressive episodes
• B Rapid cycling with ≥4 mood episodes per year
• C At least one hypomanic episode and no full manic episode ✓
• D Psychotic features during depressive episodes

Explanation

Bipolar II disorder is characterised by at least one major depressive episode and at least one hypomanic episode (duration ≥4 days, not causing marked functional impairment, no psychosis, no hospitalisation), and crucially, no lifetime manic episode. The presence of even a single full manic episode upgrades the diagnosis to Bipolar I. Rapid cycling and mixed features can occur in both types. Psychotic depression alone (without hypomania/mania) is classified as major depressive disorder with psychotic features.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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