How are mood symptoms of mania presented in the mental status exam?

• A. Depressed mood with anhedonia
• B. Elevated or expansive mood, grandiosity, increased energy, decreased need for sleep, pressured speech, distractibility, increased goal-directed activity
• C. Anxiety with avoidance behavior
• D. Euphoria with normal sleep

Answer: (B)

In mania, the mood story you elicit and observe on the mental status exam centers on an abnormally elevated or expansive mood paired with unusually high energy and activity. You’ll often see the patient describe an elated or grandiose mood, sometimes with an expansive sense of self and abilities. Behaviorally, this shows up as decreased need for sleep, meaning they can go long periods with little fatigue; pressured or rapid speech; distractibility; and a surge in goal-directed activity or psychomotor restlessness. Grandiosity is common, with inflated self-esteem or beliefs in special talents or powers. Taken together, this cluster of symptoms—elevated/expansive mood, increased energy, decreased sleep, pressured speech, distractibility, grandiosity, and heightened goal-directed activity—defines mania in the mental status exam.

This set distinguishes mania from depressive states (characterized by depressed mood and anhedonia), anxiety-driven presentations (with avoidance and physiological arousal), or milder mood elevations that don’t include decreased sleep or marked goal-directed activity.