During my last inpatient stay, there was a 60 something bipolar 1 man that had been awake for 5 days, and he was very aware that he was manic.

Part of the reason I was "undiagnosed" bipolar 1 is because I actually had a psychiatrist that listened to me explain the events that lead to my diagnosis, and the thoughts I had during those times. She said I had an unusual level of insight, and that hearing it from me, I did not sound like a bipolar 1 patient at all, so she took it off my record because it was too misleading and wasn't what she expected.