Which of the following symptoms is NOT associated with a manic episode?

A manic episode, as defined in the DSM-5, is characterized by an elevated, expansive, or irritable mood accompanied by a range of other symptoms. Increased talkativeness, a reduced need for sleep, racing thoughts, and distractibility are all hallmark features of a manic episode.

Specifically, increased talkativeness or pressure to keep talking reflects the heightened energy and enthusiasm commonly experienced during mania. A decreased need for sleep is also a typical symptom, as individuals often feel restless and may not require the same amount of rest as usual. Racing thoughts and distractibility further illustrate the frenetic pace of cognitive processes during a manic episode, where a person may jump rapidly from one idea to another.

In contrast, flat emotional expression is not characteristic of mania. Individuals experiencing a manic episode typically exhibit heightened emotional states, whether it's euphoric, irritable, or even aggressive, rather than a subdued or flat affect. This symptom more closely aligns with depressive episodes or other mood disorders, indicating a lack of emotional responsiveness rather than the exuberance typical in mania. Therefore, flat emotional expression is the correct choice as it does not fit the profile of symptoms associated with a manic episode.