Approach to mood disorders Quiz: Ace Your Exams
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A 20-year-old man comes the primary care office for evaluation of difficulty sleeping. The patient reports he has been sleeping only two hours a night for the past two weeks. He says he’s asleep for about two hours and then wakes up feeling well rested and “ready to take on the day.” He has started a new “side-gig” that he is very optimistic about in addition to his full-time job. He feels that he is able to keep up with both jobs and may consider a third. He reports that his work performance has been “excellent,” which has led to a recent raise. He has taken on multiple new hobbies recently, most of which have helped him make new friends. However, he had to dip into some of his savings to pursue these hobbies. He has no significant medical history or psychiatric history and has not had any significant life changes or stressors recently. He does not use stimulants or other recreational or prescribed substances and is drug-tested for his job regularly. Temperature is 36.5°C (97.7°F), pulse is 101/min, respirations 20/minute, blood pressure is 130/84 mmHg, and oxygen saturation is 99% on room air. Mental status exam is significant for an extremely talkative patient with a euphoric affect, increased psychomotor activity, and rapid speech. Cardiopulmonary and abdominal exams are within normal limits. Which of the following is the most likely cause of this patient’s symptoms and examination findings?
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