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Bipolar II — MRCPsych Paper B MCQ

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ModerateMood DisordersBipolar IIMRCPsych Paper B

A 35-year-old woman has previously experienced two episodes meeting diagnostic criteria for major depressive episodes. She later has a distinct 4-day period of persistently elevated mood and increased energy and activity. During this period, she needs markedly less sleep, is unusually talkative, has inflated self-esteem and experiences racing thoughts. Colleagues notice a clear change from her usual behaviour, but she continues working, has no marked functional impairment or psychotic symptoms, and does not require hospitalisation. The episode is not attributable to medication, substance use or a medical condition. She has never experienced a manic episode. Which is the most likely lifetime diagnosis?

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Correct answer: D — Bipolar II disorder

The correct answer is D, bipolar II disorder. She has had major depressive episodes and a hypomanic episode, with no lifetime manic episode. The elevated mood, increased energy and multiple associated symptoms represent a clear change from baseline, but the absence of marked impairment, hospitalisation or psychosis distinguishes hypomania from mania. Bipolar I disorder requires a manic episode. Major depressive disorder is excluded by the hypomanic episode. Cyclothymic disorder involves chronic fluctuating subthreshold depressive and hypomanic symptoms rather than full major depressive episodes. Schizoaffective disorder requires a psychotic syndrome, including psychosis occurring independently of a major mood episode, which is not present here.

Reference: NHS England, Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4, Chapter 11: Bipolar disorder, section 11.2 Definitions and assessments, 2025 (last edited 2026). https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/survey-of-mental-health-and-wellbeing-england-2023-24/bipolar-disorder