H.M. is a 23-year-old man, accompanied to the clinic by his wife, A.M. She called the clinic before.

H.M. is a 23-year-old man, accompanied to the clinic by his wife, A.M. She called the clinic before bringing him in and reported much of the following information. A.M. says that he was doing well until about 3 weeks ago, when his niece was killed in an automobile accident. At the funeral, he borrowed some “nerve pills” from his cousin. Since then, H.M. has been acting increasingly “wild.” He has been staying up later at night and often bursts into the bedroom at 2 or 3 AM and loudly awakens A.M. Sometimes, he presents her with expensive gifts, which they cannot afford. He often jumps on the bed and starts singing her love songs in a loud voice. A.M. notes that H.M. then almost always demands sex, after which he sleeps for a few hours and then loudly gets up and leaves the house. H.M. recently has experienced problems at work, where he is a snack delivery truck driver. During the last several weeks, he was noted to be loading his truck in a rapid and reckless manner. His boss received several reports that H.M. was driving unsafely and at high speeds. Store owners called to complain that he was giving away free cases of snacks to customers, and he often did not complete deliveries to the stores at the end of his route. Last week, when his boss called to express concern about his behavior, H.M. said he was quitting his job. He wrote an illegible resignation note, which was at least ten pages long, called an overnight air delivery service to send the note to his employer (who is located only 3 miles from his home), and then left the house before the driver arrived to pick it up. H.M. returned several hours later with a brand new car and wearing an expensive new suit, red cowboy boots, and a bright green hat with a large feather. He told A.M. that he had a new job, which was going to make him a millionaire. Last night, she found a large sum of money in his pants pocket when emptying the clothes hamper. He did not come home at all, but he called her at 4 AM to tell her to pack for Dallas, where he was going to become the new head coach of the professional football team. On arriving at the clinic, H.M. insists, “I don’t need no doc. I am supercalifragilistic!” He then bursts into song. He is dressed flamboyantly but needs a shave and shower. He gives the examiner (a stranger) a bear hug and has trouble sitting still, listening, or allowing others to talk. His speech is pressured and loud; he often fails to complete sentences or communicate entire ideas, and he is rhyming and punning. His mood obviously is elevated, but he becomes increasingly irritable throughout the examination. He insists he must get to Texas to sing the national anthem at a football game before the CIA can stop him; he then breaks down in tears. Within moments, he is again smiling and talking of money-making schemes. He is oriented to person and place, but thinks it is tomorrow. Intelligence seems average. When asked to interpret a proverb, H.M. becomes angry, throws a chair across the room, and yells, “Enough of this! Air Force One is waiting for me!” He then storms out of the office. How is H.M.’s presentation consistent with the diagnosis of a manic episode?