A 25-Year-Old Man Comes to the Office Due to Problems

A 25-year-old man comes to the office due to problems with concentration and restlessness.  His younger brother takes stimulants for attention-deficit hyperactivity disorder, and the patient wonders if medication will help him to focus.  He is accompanied by his girlfriend, who says, "Over the past month, he has been uncharacteristically hyperactive and irritable, jumping from one activity to another but getting little accomplished."  The patient is frustrated with his current job as a computer data entry clerk, which he feels is beneath him, and he was upset when his boss recently criticized him for making several mistakes.  His girlfriend says that he is on the verge of losing his job.  The patient stays up late developing plans for a new business that he believes will make him a millionaire.  He is sleeping 2-3 hours a night.  He drinks 3-4 alcoholic drinks a week and uses marijuana twice a month.
Physical examination is unremarkable.  Urine toxicology is positive for tetrahydrocannabinol.  On mental status examination, the patient appears restless and easily distracted.  He is very talkative and leaves his chair to pace during the interview.  His mood is irritable.  He has no suicidal ideation or psychotic features.
Which of the following is the most likely diagnosis?

A) Adjustment disorder
B) Adult attention-deficit hyperactivity disorder
C) Bipolar disorder
D) Narcissistic personality disorder
E) Substance-induced mood disorder

Correct Answer:

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