Bipolar Disorder I and II

A 32-year-old man with Bipolar Disorder I presents with a 3-week history of elevated mood, grandiosity, decreased need for sleep (3 hours/night), and pressured speech. He has been hospitalized twice before with similar presentations requiring antipsychotics. Regarding the pharmacological management of acute mania in Bipolar I disorder, all of the following are first-line agents EXCEPT:

Regarding the diagnostic criteria and clinical features that differentiate Bipolar Disorder I from Bipolar Disorder II, all of the following statements are TRUE EXCEPT:

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?

A 28-year-old man with Bipolar Disorder II is on lithium 900 mg daily (serum level 0.8 mEq/L, therapeutic range 0.6–1.2 mEq/L) and has been stable for 6 months. He now presents with a 3-day history of depressed mood, anhedonia, and suicidal ideation (passive, no plan). He denies manic or hypomanic symptoms. Lithium level is within therapeutic range, renal function is normal, and TSH is normal. What is the most appropriate next step in management?

A 28-year-old woman from Delhi presents to the psychiatry outpatient department with her husband. She reports a 3-week episode of elevated mood, decreased need for sleep (sleeping only 2 hours per night but feeling fully rested), racing thoughts, and increased goal-directed activity. She has started multiple business ventures simultaneously and has spent ₹5 lakhs on jewelry despite financial constraints. Her husband mentions she has had two similar episodes in the past 18 months, each lasting 1–2 weeks, followed by periods of normal mood lasting 2–3 months. There is no history of depressive episodes. Mental status examination reveals pressured speech, flight of ideas, and grandiose ideation. What is the most likely diagnosis?