Consider the following:

Decreased sleep: as in I “can’t sleep” versus “don’t need to sleep”.

Ruminative thinking versus racing thoughts.  “Can’t turn off my thinking” versus “thinking too fast to put it in words”.  Remember: the speed of thought is essential.

Distractibility versus tangentiality.  “Mind going blank, cant remember what I was thinking/talking about” versus “thoughts just pop up, one after another”.

Psychomotor agitation: the patient reports feeling exhausted but restless as in “I can’t stop worrying” versus hyperenergetic.

Impulsivity: as in “I wanted to kill myself as I can no longer stand feeling this way” or “I don’t think much about what to do next.”

Same or different?

Details matter.

When it comes to psychiatric history and review of systems the context is what makes or brakes your diagnosis.

Which, in the cases above, should be depression versus mania.

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