title: Mixed-state bipolar I and II depression: time to remission and clinical characteristics.
abstract: BACKGROUND
  We compared the time to achieve remission and the clinical characteristics of patients with bipolar depressive mixed state and those with bipolar depressive non-mixed state.
  
  
  METHODS
  The subjects (N=131) were inpatients diagnosed between 2006 and 2012 with bipolar I or II disorder, depression and were classified into the following three groups: "pure depressive state" (PD, n=70), "sub-threshold mixed state" (SMX, n=38), and "depressive mixed state" (DMX, n=23). Diagnosis of a DMX was in accordance with Benazzi's definition: three or more manic symptoms in a depressive episode. The subjects' charts were retrospectively reviewed to ascertain the time to achieve remission from the index episode and to identify other factors, such as demographic and clinical characteristics, specific manic symptoms, and pharmacological treatment, that may have contributed to remission.
  
  
  RESULTS
  The time to achieve remission was significantly longer in the DMX (p=0.022) and SMX (p=0.035) groups than in the PD group. Adjustment for covariates using a Cox proportional hazards model did not change these results. Clinically, subjects with a DMX were more likely to have manic symptoms in the index episode, especially inflated self-esteem and psychomotor agitation than those in the PD.
  
  
  CONCLUSIONS
  We investigated only inpatients and therefore could not comment on outpatients.
  
  
  CONCLUSIONS
  These findings showed that sub-syndromal manic symptoms in bipolar depression had different clinical characteristics and a more severe illness course, including a longer time to achieve remission, than did a pure depressive state.
authors.affiliation: Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: In Hee
authors.initials: IH
authors.lastname: Shim
authors.forename: Young Sup
authors.initials: YS
authors.lastname: Woo
authors.forename: Tae-Youn
authors.initials: TY
authors.lastname: Jun
authors.forename: Won-Myong
authors.initials: WM
authors.lastname: Bahk
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors
keywords: Benazzi's definition; Bipolar depression; Clinical characteristics; Depressive mixed state; Remission