title: Bipolar mixed states: still mixed up?
abstract: OBJECTIVE
  To provide an update regarding the nosological status of, and treatments for, bipolar mixed states.
  
  
  RESULTS
  Mixed states are increasingly recognized as relatively common. The nosological approach in DSM-5 reflects a more liberal application of a mixed states specifier to either the depressed or manic pole of bipolar disorder. The presence of mixed features is associated with a worse clinical course and higher rates of comorbidities including substance abuse. There is ongoing debate about the role of antidepressants in the evolution of such states, but there is increasing consensus that the presence of mixed features should preclude the use of antidepressants.
  
  
  CONCLUSIONS
  Clinical vigilance and careful evaluation are required to ensure mixed states are not missed in the clinical context. Atypical antipsychotics are emerging as the medications of choice in the pharmacological management of mixed states. Furthermore, research is required into the aetiogenesis and effective treatment of mixed states.
authors.forename: David J
authors.initials: DJ
authors.lastname: Castle
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D002986:Clinical Trials as Topic; D000075202:Contraindications; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D006801:Humans
chemical_list: D000928:Antidepressive Agents