title: Mania and depression. Mixed, not stirred.
abstract: OBJECTIVE
  Current criteria for mixed bipolar episode do not allow an adequate understanding of a vast majority of bipolar patients with mixed (hypo) manic-depressive features, keeping the qualification of "mixed episodes" for bipolar type I only. This study was aimed to test the existence of a bipolar-mixed continuum by comparing the characteristics of three groups classified according to patterns of past and current manic or mixed episodes.
  
  
  METHODS
  134 bipolar I inpatients were divided according to their pattern of excitatory "mixed-like" episodes in three groups: 1) lifetime history of purely manic episodes without mixed features (PMA); 2) lifetime history of both manic and mixed episodes (MIX) and 3) lifetime history exclusively of mixed, but not manic, episodes (PMIX). Differences in clinical and demographic characteristics were analyzed by using chi-square head-to-head for categorical data, one-way ANOVA for continuous variables and Tukey's post-hoc comparison. Logistic regression was used to control for data validity.
  
  
  RESULTS
  PMIX had higher rates of depressive predominant polarity and less lifetime history of psychotic symptoms, and had received more antidepressants both lifetime and during 6 months prior to index episode. PMIX had more suicide attempts and Axis I comorbidity than PMA.
  
  
  CONCLUSIONS
  PMIX is likely to have a higher risk for suicide and higher rates of comorbidities; current DSM-IV-TR criteria are not fit for correctly classifying these patients and this may affect treatment appropriateness. The concept of "mixicity" should be extended beyond bipolar I disorder to other bipolar disorder subtypes.
authors.affiliation: Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain.
authors.forename: Isabella
authors.initials: I
authors.lastname: Pacchiarotti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mazzarini
authors.forename: Giorgio D
authors.initials: GD
authors.lastname: Kotzalidis
authors.forename: Marc
authors.initials: M
authors.lastname: Valentí
authors.forename: Alessandra M A
authors.initials: AM
authors.lastname: Nivoli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Sani
authors.forename: Carla
authors.initials: C
authors.lastname: Torrent
authors.forename: Andrea
authors.initials: A
authors.lastname: Murru
authors.forename: Jose
authors.initials: J
authors.lastname: Sanchez-Moreno
authors.forename: Barbara
authors.initials: B
authors.lastname: Patrizi
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.forename: Francesc
authors.initials: F
authors.lastname: Colom
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000145:classification* / Q000188:drug therapy / Q000523:psychology*; D015897:Comorbidity; D003863:Depression; D003866:Depressive Disorder; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult