## Duration Requirement for Hypomanic Episodes **Key Point:** Hypomanic episodes have a **strict minimum duration of 4 consecutive days**. A 3-day episode, regardless of symptom severity or functional status, does NOT meet criteria for hypomania. ### Diagnostic Criteria for Hypomanic Episode (DSM-5) 1. **Duration:** ≥ **4 consecutive days** (not 3, not "most of the day") 2. **Mood:** Persistently elevated, expansive, or irritable 3. **Symptoms:** At least 3 of the following (4 if mood is only irritable): - Inflated self-esteem or grandiosity - Decreased need for sleep - More talkative than usual - Racing thoughts or flight of ideas - Distractibility - Increased goal-directed activity or psychomotor agitation - Excessive involvement in high-risk activities 4. **Functional Impairment:** **NOT required** for hypomania (this distinguishes it from mania) 5. **Psychosis:** Must NOT be present ### Why Duration Matters **High-Yield:** The 4-day threshold is **non-negotiable** in DSM-5. It is not waived for symptom severity, functional impairment, or any other reason. This is a common NEET PG trap. ### Comparison: Manic vs. Hypomanic Duration | Criterion | Manic Episode | Hypomanic Episode | | --- | --- | --- | | **Minimum Duration** | ≥ 7 days (or hospitalization) | ≥ 4 consecutive days | | **Functional Impairment** | Required (marked) | NOT required | | **Psychosis** | May be present | Must NOT be present | **Clinical Pearl:** A 3-day elevated mood episode is sometimes called a "brief hypomanic-like episode" or "subsyndromal hypomania" in clinical practice, but it does NOT meet formal diagnostic criteria and should not be coded as a hypomanic episode. **Warning:** Do not confuse "no functional impairment" (which is acceptable in hypomania) with "short duration" (which is never acceptable). Both criteria must be met independently.
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