A 40-year-old man describes months of increased energy, decreased need for sleep to four hours, heightened goal-directed activity, and pressured speech. His symptoms have never been severe enough to cause hospitalisation or marked occupational impairment. He also reports three months of persistent low mood with anhedonia earlier in the year. What is the most likely diagnosis?

• A Bipolar I disorder
• B Cyclothymic disorder
• C Persistent depressive disorder (dysthymia)
• D Bipolar II disorder ✓

Explanation

Bipolar II disorder requires at least one hypomanic episode (four or more consecutive days of elevated or expansive mood plus associated symptoms, not severe enough to cause marked impairment or require hospitalisation) and at least one major depressive episode. Bipolar I requires at least one full manic episode with marked impairment or requiring hospitalisation. Cyclothymia involves subsyndromal hypomanic and depressive symptoms over at least two years, not meeting full episode criteria.

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

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