What questions should be asked to evaluate a patient for mania in bipolar 1 disorder?

Screening Questions to Assess for Mania in Bipolar 1 Disorder

Ask about distinct, spontaneous periods of abnormally elevated, expansive, or irritable mood lasting at least 7 days (or any duration if hospitalization required), accompanied by increased energy/activity and decreased need for sleep—these are the hallmark features that differentiate mania from other conditions. 1, 2

Core Screening Questions

Mood and Energy Changes

• "Have you had periods lasting at least a week where your mood was abnormally high, euphoric, or extremely irritable—clearly different from your usual self?" This identifies the cardinal mood criterion required for diagnosis 1, 2
• "During these times, did you have much more energy than usual or feel driven to be constantly active?" Increased energy/activity is the most important symptom for diagnosing mania, more so than mood changes alone 3, 1
• "Did these mood and energy changes represent a clear departure from how you normally function?" Manic episodes must be distinct from baseline functioning, not chronic temperamental patterns 1, 2

Sleep Disturbance

• "During these periods, did you need much less sleep than usual but still feel rested or full of energy?" Decreased need for sleep (not just insomnia) is a hallmark sign that must be differentiated from sleep problems due to other causes 1, 2

Associated Manic Symptoms (Need at least 3)

• "Were you much more talkative than usual, or did you feel pressure to keep talking?" 1
• "Did your thoughts race, or did you have so many ideas that you couldn't keep up with them?" 1
• "Did you feel unusually important, powerful, or like you had special abilities?" This assesses grandiosity, which must represent a marked change rather than baseline personality 1, 2
• "Were you easily distracted, jumping from one activity to another?" 1
• "Did you become much more goal-directed or restless, taking on multiple projects at once?" This evaluates psychomotor agitation and increased goal-directed activity 1
• "Did you engage in risky activities like spending sprees, sexual indiscretions, or reckless driving that could have serious consequences?" 1

Temporal Pattern Assessment

• "How long did these episodes last—days, weeks, or months?" Episodes must last at least 7 days for mania (or any duration if hospitalization required) 1, 2
• "Were these changes episodic with clear beginnings and endings, or have they been constant?" Use a life chart approach to map longitudinal patterns and distinguish episodic mania from chronic conditions 2, 4
• "What was happening in your life when these episodes started—were they spontaneous or triggered by specific events?" This differentiates true mania from reactive mood changes 2

Functional Impairment and Severity

• "Did these changes cause serious problems at work, school, relationships, or lead to hospitalization?" Marked impairment across multiple life domains is required 1, 2
• "During these times, did you experience hallucinations, delusions, or lose touch with reality?" Psychotic symptoms are common in adolescent mania 1

Critical Differential Diagnosis Questions

Distinguishing from Other Conditions

• "Have you been using alcohol, drugs, or any medications (including antidepressants) when these symptoms occurred?" Antidepressant-induced mania is classified as substance-induced per DSM criteria 2, 5
• "Is your irritability constant and present most of the time, or does it come in distinct episodes?" Chronic irritability suggests ADHD or disruptive behavior disorders rather than bipolar disorder 1, 2
• "Do your mood changes happen in response to specific situations or trauma reminders?" This differentiates PTSD-related reactivity from spontaneous manic episodes 2

Family and Treatment History

• "Does anyone in your biological family have bipolar disorder, depression, or other mood disorders?" Family history increases diagnostic likelihood 2
• "Have you ever been treated with antidepressants, and if so, did they make you agitated, hyperactive, or cause mood elevation?" This may unmask underlying bipolar disorder 6, 2

Safety Assessment

• "During or after these episodes, have you had thoughts of harming yourself or ending your life?" Bipolar disorder has extremely high rates of suicide attempts requiring thorough evaluation 2
• "Have you had thoughts of harming others or acted aggressively?" 2

Age-Specific Considerations

In Adolescents and Children

• Focus on irritability, belligerence, and mixed features rather than euphoria alone, as these are more common in juvenile presentations 1
• Ask about psychotic symptoms specifically, as they frequently accompany adolescent mania 1
• In children under age 6, exercise extreme caution, as diagnostic validity has not been established in this age group 2

Common Pitfalls to Avoid

• Do not diagnose mania based on irritability alone—it lacks specificity and occurs across multiple childhood disorders 1, 2
• Distinguish between behavioral activation from SSRIs (occurs in first month, improves with dose reduction) and true mania (may appear later, persists despite medication changes) 1
• Do not confuse ADHD symptoms with mania—ADHD is chronic from early childhood, while mania is episodic with clear onset 1, 2
• Obtain collateral information from family members, as patients often lack insight during manic episodes and cannot reliably describe their own behavioral changes 2