A 31-year-old female was diagnosed with major depressive disorder four months ago and started on fluoxetine 20 mg daily. She presented to the clinic three weeks ago with improved mood and the dose was maintained. She now presents with her partner, who reports she has been sleeping only 4 hours per night for the past 10 days without feeling tired, has spent $8,000 on an impulsive online shopping spree, is talking rapidly and jumping between topics, and started three new business projects simultaneously. Her YMRS score is 28. She has no prior history of mania or hypomania, but her maternal aunt has bipolar I disorder. The patient herself reports feeling better than she has in years and does not believe anything is wrong. The PMHNP is evaluating this presentation. Which of the following best represents the appropriate clinical evaluation?