Bipolar mania — RACGP Fellowship MCQ

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HardMental healthBipolar maniaRACGP Fellowship

A 26-year-old man is brought by his partner because he has slept two hours nightly for a week, is spending excessively and believes he has special powers. Urine drug screen is negative, pulse is 96/min and he is verbally aggressive. What is the most likely diagnosis?

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Correct answer: B — Acute mania

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

The diagnosis is **acute mania** (D). This patient meets full DSM-5 manic episode criteria: irritable mood plus increased goal-directed activity sustained for 1 week, with three or more B symptoms (grandiosity, drastically decreased sleep need, excessive spending/increased activity). The negative drug screen rules out substance-induced mania. Generalised anxiety (A), OCD (B), adjustment disorder (C) and persistent depressive disorder (E) do not explain the combination of grandiosity, markedly reduced sleep with feeling rested, excessive goal-directed spending, and irritability over one week. Early recognition and urgent referral to psychiatry for pharmacological management (mood stabiliser ± antipsychotic) and safety assessment are essential.

Reference: DSM-5 manic episode criteria and Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (bipolar disorder). RACGP bipolar disorder management guidance: https://mentalhealth.racgp.org.au/guidelines/index/52558396-7a47-4930-977f-2c93e60aa8c2