Bipolar II Disorder Masked by Substance Use

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To the Editor: According to the DSM-5, bipolar II disorder is a mood disorder characterized by at least 1 hypomanic episode and at least 1 major depressive episode. The patient with hypomania has elevated mood, or irritable mood, present nearly every day for at least 4 consecutive days.

It is not uncommon for these patients to self-medicate with alcohol, and accurate diagnosis of bipolar II disorder is often delayed.