Mood disorders Quiz: Ace Your Exams

A 28-year-old woman is brought to the clinic by her partner for evaluation of odd behavior. They state that over the past week, she has been calling old friends from college and high school to “catch up” and invest in a new business for rescuing abandoned dogs. The patient states she recently became passionate about animal abuse and wants to “end the suffering of all dogs.” Her partner found her journal which described an extensive plan to break into pet stores and set the animals free. She has been sleeping for 2-3 hours/night for the past week to work on her new business. The patient’s past medical history includes major depression during college. She does not take any medications. Vitals are within normal limits. Urine toxicology is positive for tetrahydrocannabinol. Mental status examination reveals a fidgety woman, pacing back and forth. Her speech is loud, pressured, and accelerated. Her thought process is disorganized. She describes her mood as “the best it's been in years.” There is no suicidal or homicidal ideation. She denies hearing voices or hallucinations. Which of the following is the most likely diagnosis?