Which statement best differentiates a manic/hypomanic episode from a depressive episode in bipolar disorder on first assessment?

• A. Mania/hypomania includes elevated or irritable mood with increased energy and decreased need for sleep
• B. Mania is always delusional
• C. Depression never includes fatigue
• D. Bipolar disorder cannot have depressive episodes

Answer: (A)

The distinguishing feature on first assessment is the presence of an elevated or irritable mood with markedly increased energy and a decreased need for sleep. This combination is characteristic of manic or hypomanic states and sets them apart from depressive episodes, which center on low mood, anhedonia, and fatigue rather than heightened energy or sleep reduction. Mania can include psychotic features like delusions, but delusions are not required for mania. Depression frequently involves fatigue and sleep disturbances, but not a decreased need for sleep. Bipolar disorder can include depressive episodes, so the statement that it cannot is incorrect.