A 29-year-old female presents with a history of recurrent depressive episodes and periods of elevated mood lasting 7-10 days during which she sleeps only 3 hours per night, starts multiple business ventures, and exhibits pressured speech. Her partner reports that during the most recent episode she was fired from her job after making impulsive decisions and was brought to the emergency department by police after being found directing traffic at a busy intersection in her nightgown. She has never experienced psychotic symptoms.