title: Reevaluation of patients with bipolar disorder on manic episode: improving the diagnosing of mixed episode.
abstract: Mixed manic/depressive episodes in patients with bipolar disorder are underdiagnosed because of restrictive diagnostic criteria. Using the broader definition of a mixed episode represented by the Cincinnati criteria, we reevaluated the medical records of patients with bipolar disorder hospitalized for a manic episode. We also examined the predictive power of previously unrecognized depressive symptoms. Of 520 inpatients with mania, we retrospectively diagnosed 59 (11.3%) as having a probable mixed episode. Compared with the patients with pure mania, the patients with mixed episodes were more likely to have a family history of psychiatric illness, comorbid personality disorder, and a history of suicide attempts. Binary logistic regression revealed that loss of interest, loss of energy, feelings of worthlessness, and feelings of helplessness had good positive predictive value (>0.7) for mixed episodes. Accurate diagnosis of mixed episodes may require a broadening of diagnostic criteria and emphasis on symptoms such as loss of interest, loss of energy, and feelings of worthlessness and helplessness.
authors.affiliation: Department of Psychiatry, College of Medicine, Yonsei University, Seoul, South Korea.
authors.forename: Kyung Ran
authors.initials: KR
authors.lastname: Kim
authors.forename: Hyun-Sang
authors.initials: HS
authors.lastname: Cho
authors.forename: Se Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jeong-Ho
authors.initials: JH
authors.lastname: Seok
authors.forename: Eun
authors.initials: E
authors.lastname: Lee
authors.forename: Duk-In
authors.initials: DI
authors.lastname: Jon
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies