A 45-year-old man has recurrent episodes of elevated mood with decreased sleep, increased goal-directed activity, and grandiosity lasting 3-4 days. These episodes are distinct from his usual self and represent a clear change in behavior, but he functions without hospitalization. He also has major depressive episodes. The diagnosis is:
- A Bipolar II disorder ✓
- B Bipolar I disorder
- C Cyclothymia
- D Major depressive disorder with mixed features
Correct answer: A. Bipolar II disorder
Explanation
Bipolar II disorder is defined by hypomanic episodes (duration ≥4 days, clear behavioral change, observed by others, but no hospitalization, no psychosis, and no marked functional impairment) plus at least one major depressive episode. Bipolar I requires at least one manic episode (≥7 days or requiring hospitalization). Cyclothymia involves subthreshold hypomanic and depressive symptoms for ≥2 years, never meeting full episode criteria.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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