A 20- year-old man has presented with increased alcohol consumption and
sexual indulgence, irritability, lack of sleep, and not feeling fatigued even on
prolonged periods of activity. All these changes have been present for 3 weeks.
The most likely diagnosis is:
1. Alcohol dependence.
4. Impulsive control disorder.
A Short Textbook of Psychiatry by Ahuja 4 ed Page 65
Features of Manic Episodes (at least for 1 week) include
1. Elevated, Expansive or Irritable Mood
Euphoria Mild Elevation of Mood Psychological Well being Hypomania Stage I
Elation Moderate Elevation of Mood Increased psychomotor activity Classical
Mania Stage II
Exaltation Severe Elevation of Mood Intense Elation with Delusion of Grandeur
Severe Mania Stage III
Ecstasy Very Severe Elevation of Mood Intense sense of Rapture Delirious or
Stuporous Mania Stage IV
2. Psychomotor Activity
a. Overactiveness and Restlessness
b. Activity is Goal Oriented
c. Patient is on the go
3. Speech and thought
a. More talkative, Describes thoughts racing in Mind, develops pressure of
speech, uses playful language with puning, rhyming, joking and teasing
b. Flight of Ideas
4. Goal directed Activity
a. Ability to function is better.
b. Many artists and writers contribute significantly
5. Other features
a. Sleep reduced
b. Insight Absent
c. Mood Incongruent psychotics features may be present
6. Absence of Underlying Organic Cause
1. Other than that he takes Alcohol, no other feature supports Alcohol
2. Schizophrenia rarely presents like this.
3. Mania is the correct diagnosis for this patient. We can see that all the
features that are seen in this patient are the ones seen in Mania
4. Impulsive control disorder does not present like this. Please look at the
other question for Impulse control disorders
If you cannot match the answer at the first attempt, try exclusion of the other
choices. But keep in mind that there are negative marks in these exams !!
Mania and Depression along with Schizophrenia, Delusion, Hallucination, Drug
dependence are the common topics from which you will get questions and these
question will be answered by the majority and if you leave a question in these
topics, you may be left out in the race
Explanation By Dr Bruno, Author of