# Situation: A 27-year-old woman is admitted to the psychiatric unit with a manic episode. For 10 days she has slept 2 to 3 hours a night, spent all her savings on clothes, and talked almost nonstop. She has lost 3 kg in the past week because she will not sit down to eat. She has no other medical illness. Her record describes an earlier episode 2 years ago. For 5 days she was unusually cheerful and talkative, slept about 4 hours a night without feeling tired, and started several projects at once. On the fifth day her family brought her to a psychiatric ward, where she stayed 3 days until her mood settled. She had no delusions or hallucinations and was taking no medicines or substances at that time. How is that earlier episode BEST classified?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630079  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 27-year-old woman is admitted to the psychiatric unit with a manic episode. For 10 days she has slept 2 to 3 hours a night, spent all her savings on clothes, and talked almost nonstop. She has lost 3 kg in the past week because she will not sit down to eat. She has no other medical illness.

Her record describes an earlier episode 2 years ago. For 5 days she was unusually cheerful and talkative, slept about 4 hours a night without feeling tired, and started several projects at once. On the fifth day her family brought her to a psychiatric ward, where she stayed 3 days until her mood settled. She had no delusions or hallucinations and was taking no medicines or substances at that time. How is that earlier episode BEST classified?

## 보기

1. A hypomanic episode
2. A manic episode **✔ 정답**
3. Cyclothymic disorder
4. A normal high mood, not an episode

**정답: 2**

## 해설

A manic episode requires abnormally elevated mood with increased energy for at least 1 week, or for any duration if hospitalization is necessary, plus at least 3 additional symptoms. She had elevated mood with reduced need for sleep, talkativeness, and increased goal-directed activity, and she was hospitalized for it, so the episode is manic even though it lasted only 5 days. A hypomanic episode by definition never leads to hospitalization.

## 심화 해설

Core diagnostic reasoning

The earlier episode lasted 5 days, which is shorter than the usual 1-week duration threshold for a manic episode. However, the duration criterion is not the only path to a manic diagnosis. A manic episode can be diagnosed for any duration if hospitalization is required. In this case, the family brought her to a psychiatric ward on the fifth day, and she stayed for 3 days until her mood settled. That hospitalization makes the episode qualify as manic, not hypomanic.

Hypomanic episode is defined by a clear change in functioning that is observable by others, but it is never severe enough to cause marked impairment or to require hospitalization. Once hospitalization occurs, the episode crosses the threshold into mania. This is a fixed rule in diagnostic classification: the need for inpatient care overrides the duration requirement.

Symptom count and clinical picture

During those 5 days, she presented with an abnormally elevated mood plus at least three additional symptoms: reduced need for sleep, unusual talkativeness, and increased goal-directed activity. She also had no delusions or hallucinations and was not using substances or medicines, so the episode was not better explained by another condition. These features are consistent with a manic episode, not merely a high mood.

Watch out! A common error is to equate short duration with hypomania. Duration alone does not decide the classification when hospitalization is present. The hospitalization criterion is decisive.

Why cyclothymic disorder is not the answer

Cyclothymic disorder involves numerous periods of hypomanic and depressive symptoms over at least 2 years that do not meet full criteria for a manic, hypomanic, or major depressive episode. Here, the episode did meet full criteria for mania because of hospitalization, so cyclothymic disorder is excluded.

Diagnostic threshold comparison

| Feature | Hypomanic episode | Manic episode |
| --- | --- | --- |
| Minimum duration | 4 days | 1 week or any duration if hospitalized |
| Hospitalization | Never required | May be required, and if so, duration rule is waived |
| Functional impairment | Mild, observable change | Marked impairment or need for inpatient care |
| Psychotic features | Absent | May be present |

Applying the rule to this patient

The earlier episode involved elevated mood, reduced need for sleep, talkativeness, and increased activity, and it ended with a 3-day psychiatric admission. Because hospitalization occurred, the episode is classified as manic, even though the total duration was only 5 days. The absence of delusions or hallucinations does not change this; psychotic features are not required for a manic episode.

Key point! In bipolar spectrum classification, the need for hospitalization is a severity marker that automatically upgrades an episode from hypomanic to manic, regardless of how many days the symptoms lasted.

## 임상 시나리오

Manic Episode Classification: Hospitalization Overrides DurationA 5-day episode requiring admission is still mania, not hypomania
A manic episode requires elevated mood plus increased energy for at least 1 week, or for any duration if hospitalization is necessary. Inpatient care is a severity marker that automatically crosses the threshold from hypomania to mania.

A hypomanic episode is defined as a clear functional change observable by others but never severe enough to cause marked impairment or require hospitalization. Once admission occurs, the diagnosis shifts to mania regardless of symptom duration.

CautionDo not equate short duration with hypomania. When hospitalization is present, the duration criterion is overridden. Also rule out substance-induced or medical causes before diagnosing a primary mood episode.

## 핵심 개념

- **Manic episode** — Abnormally elevated or irritable mood with increased energy lasting at least 1 week, or any duration if hospitalization is required, plus at least 3 additional symptoms.
- **Hypomanic episode** — A distinct period of elevated or irritable mood with increased energy lasting at least 4 days that is observable by others but never causes marked impairment or requires hospitalization.
- **Cyclothymic disorder** — A chronic mood disorder with numerous periods of hypomanic and depressive symptoms over at least 2 years that do not meet full episode criteria.
- **Reduced need for sleep** — A core symptom of mania or hypomania in which the person sleeps significantly less than usual yet feels rested and energetic.

## 같은 주제 문제

- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629966)
- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629967)
- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629968)
- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629969)
- [Situation: The nurse in a community mental health program leads a psychoeducation session …](https://mymerci.kr/pages/nclex_q.php?qn_id=629970)
- [Situation: The nurse in a community mental health program leads a psychoeducation session …](https://mymerci.kr/pages/nclex_q.php?qn_id=629971)
- [Situation: The nurse in a community mental health program leads a psychoeducation session …](https://mymerci.kr/pages/nclex_q.php?qn_id=629972)
- [Situation: A 29-year-old factory worker is admitted to the psychiatric unit of a general h…](https://mymerci.kr/pages/nclex_q.php?qn_id=629973)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._