282 Mixed Episode

DSM-IV-TR criteria

• A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
• B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or there are psychotic features.
• C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

• NOTE: Mixed-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electro-convulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Associated features

• Individuals may have disorganized thoughts or behavior. They may also experience dysphoria, or a sense of good feeling and in a daze. These individuals may be more likely to seek out for help. They also have similar features found in severe Major Depressive episodes such as experiencing manic episodes.

Child vs. adult presentation

• Mixed episodes appear to be more common in younger individuals and in individuals over age 60 years with Bipolar I Disorder and may be more common in males than in females.

Gender and cultural differences in presentation

• It affects all races.
• Latinos and Mediterranean cultures complain about nerves and headaches.
• Chinese and Asian cultures complain about weakness, tiredness, or imbalance.
• Middle Eastern cultures complain about problems of the heart or heartbreak.
• May be more common in males than females
• Males tend to report experiencing manic symptoms first, while women report feeling the depressive symptoms.

Epidemiology

• There is evidence of this disorder in no more than 1% of the general population, and even less in clinical settings where the ones remitted to the population is a very small percentage in the clinical population of patients.

Etiology

• Features are similar to those for Manic Episodes and Major Depressive Episodes. Individuals may be disorganized in their thinking or behavior. Because individuals in Mixed Episodes experience more dysphoria than do those in manic Episodes, they may be more likely to seek help.
• Laboratory findings for Mixed Episode are not well studied, although evidence to date suggests physiological and endocrine findings that are similar to those found in severe Major Depressive Episodes.
• Mixed episodes, according to the DSM, require a full mania and full depresssion, psychiatrists use the term mixed episode to define this term.

Empirically supported treatments

• The first step that must be taken is a accurate diagnosis. Here therapists should assess for comorbidities and make clear the targets that need to be further examined during therapy. Typically antipsychotics or divalproex have been shown to be effective. Most therapists try to avoid the use of antidepressants.

DSM-V

• From the DSM-IV, Mixed-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.
• The Mixed Episode will be replaced with Mixed features specifier.