title: A clinical study comparing manic and mixed episodes in patients with bipolar disorder.
abstract: OBJECTIVE
  Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics.
  
  
  METHODS
  Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores.
  
  
  RESULTS
  Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared. Patients with mixed episodes were younger.
  
  
  CONCLUSIONS
  In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies.
authors.affiliation: Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, Department of Psychiatry, Universidade de São Paulo Medical School, São Paulo (SP), Brazil. schwangela@terra.com.br
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Schwartzmann
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Amaral
authors.forename: Cilly
authors.initials: C
authors.lastname: Issler
authors.forename: Sheila C
authors.initials: SC
authors.lastname: Caetano
authors.forename: Renata S
authors.initials: RS
authors.lastname: Tamada
authors.forename: Karla Mathias de
authors.initials: KM
authors.lastname: Almeida
authors.forename: Marcia Brito de Macedo
authors.initials: MB
authors.lastname: Soares
authors.forename: Rodrigo da Silva
authors.initials: Rda S
authors.lastname: Dias
authors.forename: Cristiana C
authors.initials: CC
authors.lastname: Rocca
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
mesh_terms: D000208:Acute Disease; D000328:Adult; D001714:Bipolar Disorder / Q000145:classification / Q000523:psychology*; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric