title: [Mixed depressions: clinical and neurophysiological biomarkers].
abstract: Epidemiological studies of major depressive episodes (MDE) highlighted the frequent association of symptoms or signs of mania or hypomania with depressive syndrome. Beyond the strict definition of DSM-IV, epidemiological recognition of a subset of MDE characterized by the presence of symptoms or signs of the opposite polarity is clinically important because it is associated with pejorative prognosis and therapeutic response compared to the subgroup of "typical MDE". The development of DSM-5 took into account the epidemiological data. DSM-5 opted for a more dimensional perspective in implementing the concept of "mixed features" from an "episode" to a "specification" of mood disorder. As outlined in the DSM-5: "Mixed features associated with a major depressive episode have been found to be a significant risk factor for the development of bipolar I and II disorder. As a result, it is clinically useful to note the presence of this specifier for treatment planning and monitoring of response to therapeutic". However, the mixed features are sometimes difficult to identify, and neurophysiological biomarkers would be useful to make a more specific diagnosis. Two neurophysiological models make it possible to better understand MDE with mixed features : i) the emotional regulation model that highlights a tendency to hyper-reactive and unstable emotion response, and ii) the vigilance regulation model that highlights, through EEG recording, a tendency to unstable vigilance. Further research is required to better understand relationships between these two models. These models provide the opportunity of a neurophysiological framework to better understand the mixed features associated with MDE and to identify potential neurophysiological biomarkers to guide therapeutic strategies.
authors.affiliation: Unité de neurophysiologie, psychophysiologie et neurophénoménologie (UNPN), Solaris, pôle de psychiatrie universitaire, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France; Laboratoire de neurosciences cognitives (LNC), UMR CNRS 7291, 31 Aix-Marseille Université, Site St-Charles, 3, place Victor-Hugo, 13331 Marseille cedex 3, France. Electronic address: jarthur.micoulaud@gmail.com.
authors.forename: J-A
authors.initials: JA
authors.lastname: Micoulaud Franchi
authors.affiliation: INSERM, U955, psychiatrie génétique, 94000 Créteil, France; AP-HP, Hôpital A. Chenevier, pôle de psychiatrie, centre expert bipolaire, 94000 Créteil, France; Pôle de psychiatrie, université Lille-Nord de France, CHRU de Lille, 59000 Lille, France.
authors.forename: P-A
authors.initials: PA
authors.lastname: Geoffroy
authors.affiliation: Unité de neurophysiologie, psychophysiologie et neurophénoménologie (UNPN), Solaris, pôle de psychiatrie universitaire, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France; Laboratoire de neurosciences cognitives (LNC), UMR CNRS 7291, 31 Aix-Marseille Université, Site St-Charles, 3, place Victor-Hugo, 13331 Marseille cedex 3, France.
authors.forename: J
authors.initials: J
authors.lastname: Vion-Dury
authors.affiliation: Unité de neurophysiologie, psychophysiologie et neurophénoménologie (UNPN), Solaris, pôle de psychiatrie universitaire, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France; Laboratoire de neurosciences cognitives (LNC), UMR CNRS 7291, 31 Aix-Marseille Université, Site St-Charles, 3, place Victor-Hugo, 13331 Marseille cedex 3, France.
authors.forename: C
authors.initials: C
authors.lastname: Balzani
authors.affiliation: SHU psychiatrie adultes, Solaris, Hôpital Sainte-Marguerite, 13274 Marseille cedex 09, France.
authors.forename: R
authors.initials: R
authors.lastname: Belzeaux
authors.affiliation: SHU psychiatrie adultes, Solaris, Hôpital Sainte-Marguerite, 13274 Marseille cedex 09, France.
authors.forename: M
authors.initials: M
authors.lastname: Maurel
authors.affiliation: SHU psychiatrie adultes, Solaris, Hôpital Sainte-Marguerite, 13274 Marseille cedex 09, France.
authors.forename: M
authors.initials: M
authors.lastname: Cermolacce
authors.affiliation: SHU psychiatrie adultes, Solaris, Hôpital Sainte-Marguerite, 13274 Marseille cedex 09, France.
authors.forename: E
authors.initials: E
authors.lastname: Fakra
authors.affiliation: SHU psychiatrie adultes, Solaris, Hôpital Sainte-Marguerite, 13274 Marseille cedex 09, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Azorin
mesh_terms: D000339:Affect / Q000502:physiology; D001143:Arousal / Q000502:physiology; D001288:Attention / Q000502:physiology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D001921:Brain / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004569:Electroencephalography; D004644:Emotions / Q000502:physiology; D006801:Humans
keywords: Arousal; Bipolar disorders; Depression; Dépression; Electro-encephalography; Electro-encéphalographie; Emotional reactivity; Eveil; Réactivité émotionnelle; Régulation de la vigilance; Troubles bipolaires; Vigilance regulation