A 28-year-old man is brought to the emergency department by his roommate, who is concerned about his change in behavior over the past 2 weeks. The roommate describes the patient as "a regular guy who is usually very responsible." Last week, the patient abruptly quit his job as a computer programmer and started placing large bets on an online gambling site because he was "sure to make millions." The roommate says that the patient has been staying up most nights scribbling notes for his autobiography on small scraps of paper. The patient says, "My new mission is to spread understanding." He denies any alcohol or drug use, which his roommate affirms. This patient is most likely to exhibit which of the following additional findings?

Question

A 28-year-old man is brought to the emergency department by his roommate, who is concerned about his change in behavior over the past 2 weeks.  The roommate describes the patient as "a regular guy who is usually very responsible."  Last week, the patient abruptly quit his job as a computer programmer and started placing large bets on an online gambling site because he was "sure to make millions."  The roommate says that the patient has been staying up most nights scribbling notes for his autobiography on small scraps of paper.  The patient says, "My new mission is to spread understanding."  He denies any alcohol or drug use, which his roommate affirms.  This patient is most likely to exhibit which of the following additional findings?

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11ec160b_360a_78bd_9249_2bfc535ed623_MD0001_00 This patient's grandiose ideas about his special mission, impulsive risk-taking behavior, and decreased need for sleep lasting ≥1 week are suggestive of a manic episode consistent with bipolar I disorder. Other features of mania include elevated/euphoric/irritable mood, increased energy, and hyperactivity. Increased production, volume, and rate of speech (ie, pressured speech) and a sense that one's thoughts are moving very quickly (ie, racing thoughts) are also common. Diagnosis of bipolar I disorder requires ≥1 manic episodes, although most bipolar patients will experience both major depressive and manic episodes in their lifetime. Manic episodes can occur with or without psychotic features (eg, delusions, hallucinations). Pharmacotherapy for acute mania includes mood stabilizers such as lithium and valproate and second-generation antipsychotics (eg, risperidone). (Choices A, C, and G) Flat affect (ie, reduced emotional expressiveness), decreased attention to personal hygiene, and thought blocking (ie, sudden inability to finish a thought) are findings typical of schizophrenia. In contrast, patients with bipolar disorder exhibit intense and labile affect, increased thought productivity, and pressured speech. These patients may wear garish clothing and makeup but typically do not neglect their hygiene. (Choices B, E, and F) Low self-esteem, psychomotor slowing (ie, slow speech and movements), and social withdrawal are more typical of a major depressive episode. Patients in a manic episode are typically grandiose or overconfident, physically restless and hyperactive, and expansive (eg, overly friendly and eager to talk to strangers). Educational objective: Manic episodes are characterized by euphoric/irritable mood, impulsivity, hyperactivity, decreased need for sleep, pressured speech, racing thoughts, and grandiosity. They may occur with or without psychotic features. __________ References: Bipolar disorder. (http://www.ncbi.nlm.nih.gov/pubmed/26388529) The diagnosis and management of bipolar I and II disorders: clinical practice update. (http://www.ncbi.nlm.nih.gov/pubmed/28888714)

A 28-Year-Old Man Is Brought to the Emergency Department by His