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Bipolar I — MRCPsych Paper B MCQ

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ModerateMood DisordersBipolar IMRCPsych Paper B

A 40-year-old man had a severe depressive episode 2 years ago, which remitted following CBT and sertraline. Sertraline was stopped 12 months ago. For the past 8 days, he has had persistently elevated mood and markedly increased activity, with pressured speech, grandiosity, distractibility and a reduced need for sleep. He has spent £12,000 on unrealistic business ventures and has been suspended from work because of his behaviour. He has no psychotic symptoms, substance misuse or evidence of a causative medical condition. Which is the most likely diagnosis?

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Correct answer: D — Bipolar I disorder, current manic episode

The correct answer is **bipolar I disorder, current manic episode**. He has a sustained syndrome of elevated mood and increased activity lasting longer than one week, with pressured speech, grandiosity, reduced need for sleep, distractibility and reckless spending. The marked financial and occupational consequences establish mania rather than hypomania; psychotic symptoms are not required. A manic episode establishes bipolar I disorder and excludes both major depressive disorder and bipolar II disorder. Bipolar II involves depressive episodes and hypomania but no history of mania. Schizoaffective disorder requires a psychotic syndrome, including psychosis occurring outside prominent mood episodes, which is absent. Cyclothymic disorder involves chronic fluctuating subthreshold depressive and hypomanic symptoms rather than a full manic episode.

Reference: Royal College of Psychiatrists. Bipolar disorder, sections “What types of bipolar disorder are there?” and “Mania” (current web resource; accessed 19 August 2026). https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/bipolar-disorder