Bipolar Disorder I and II

A 32-year-old man presents with a 3-week history of elevated mood, decreased need for sleep (4 hours/night), racing thoughts, and increased goal-directed activity. He reports a previous depressive episode lasting 2 months 18 months ago. Physical examination and basic metabolic panel are unremarkable. Which investigation is most appropriate to confirm the diagnosis and rule out secondary causes?

A 28-year-old woman with a diagnosis of Bipolar Disorder II (confirmed by 2 prior hypomanic episodes and recurrent major depressive episodes) presents for routine follow-up. She is currently euthymic on lithium monotherapy. Before initiating long-term lithium maintenance, which investigation is most appropriate to establish baseline renal and cardiac safety?

A 32-year-old man presents with a 3-week history of elevated mood, decreased need for sleep (3–4 hours), racing thoughts, and increased goal-directed activity. He has had two previous similar episodes separated by 8 months of euthymia, and one depressive episode lasting 2 weeks. Which investigation is most appropriate to confirm the diagnosis and rule out secondary causes?

A 28-year-old woman with a 6-year history of bipolar II disorder (recurrent hypomanic episodes and major depressive episodes) is being evaluated for treatment optimization. She has been on lithium for 2 years. Which investigation is most appropriate to assess long-term safety and guide ongoing therapy?

A 32-year-old woman with Bipolar Disorder I presents to the emergency department with acute mania: elevated mood, flight of ideas, decreased need for sleep (2 hours), and increased goal-directed activity for 5 days. She is not on any mood stabilizer. Vital signs are stable, physical examination is unremarkable, and basic metabolic panel is normal. What is the most appropriate immediate next step in management?