hypomania

Meaning: Hypomania is a distinct period of abnormally elevated, expansive, or irritable mood with increased energy or activity. Typical features are decreased need for sleep, talkativeness, racing thoughts, distractibility, inflated self-esteem, and risky behavior. Others notice the change, but the person keeps functioning without marked impairment. There are no hallucinations or delusions, and hospitalization is not required. DSM-5 criteria call for at least four consecutive days.

On the MCAT: A vignette describes several days of little sleep, high productivity, and fast speech in someone who still works and relates normally, with a history of major depressive episodes. The answer is bipolar II. If the episode lasts about a week or more, causes marked impairment such as job loss, involves psychotic features, or needs hospitalization, it is mania, which defines bipolar I. Questions may ask you to rank episodes by severity or match a description to a disorder.

Common confusion: Students treat hypomania as simply a shorter mania. The distinction rests on severity and impairment, not only duration, and psychosis or hospitalization makes an episode manic by definition. Bipolar II is also not necessarily the milder disorder overall, because its depressive episodes can be prolonged and severe.