title: [Mixed states and schizophrenia].
abstract: Because of their compilation of contrasted symptoms and their variable clinical presentation, mixed episodes have been withdrawn from the DSM. However, mixed states question not only the bonds between depression and mania, but also the distinction between bipolar disorders and schizophrenia. Indeed, doubts about the dichotomy introduced by Kraepelin between bipolar disorders and schizophrenia is as old as the nosolgy itself, as attest the later works of this author revealing his hesitations on his own classification. But findings here reviewed issued from recent technical advances, particularly in the imaging and genetic fields, offer a better understanding of the boundaries between these two disorders. Yet, when confronted to an acute episode, clinicians may find it challenging to distinguish a mixed state from a schizophrenic relapse. Indeed, there is no pathognomonic manifestation allowing to retain a diagnosis with confidence. The physician will therefore have to identify a pattern of signs, which will orient his assessment with no certainty. Thus, negative rather than affective or psychotic symptomatology appears to be useful in discriminating schizophrenia (or schizoaffective) disorders from mixed mania. However, a conclusion during this acute stage appears in definitive a formal exercise, first because the final diagnosis will only be ascertained once the symptoms are amended, and second because, according to our classifications, a mood episode, including mania and mixed mania, can be observed without ruling out the diagnosis of schizophrenia.
authors.affiliation: SHU psychiatrie adultes - pavillon Solaris, hôpital Sainte-Marguerite, 13274 Marseille Cedex 09, France. Electronic address: eric.fakra@ap-hm.fr.
authors.forename: E
authors.initials: E
authors.lastname: Fakra
authors.affiliation: SHU psychiatrie adultes - pavillon Solaris, hôpital Sainte-Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: R
authors.initials: R
authors.lastname: Belzeaux
authors.affiliation: Clinique de psychiatrie et de psychologie médicale, CHU Pasteur, 06002 Nice Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Pringuey
authors.affiliation: SHU psychiatrie adultes - pavillon Solaris, hôpital Sainte-Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: M
authors.initials: M
authors.lastname: Cermolacce
authors.affiliation: SHU psychiatrie adultes - pavillon Solaris, hôpital Sainte-Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: N
authors.initials: N
authors.lastname: Corréard
authors.affiliation: SHU psychiatrie adultes - pavillon Solaris, hôpital Sainte-Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: J-A
authors.initials: JA
authors.lastname: Micoulaud-Franchi
authors.affiliation: SHU psychiatrie adultes - pavillon Solaris, hôpital Sainte-Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Azorin
mesh_terms: D001714:Bipolar Disorder / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D003072:Cognition Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D011618:Psychotic Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D012008:Recurrence; D012559:Schizophrenia / Q000145:classification* / Q000175:diagnosis*; D012565:Schizophrenic Psychology
keywords: Bipolar disorders; DSM; Mixed states; Psychose unique; Schizophrenia; Schizophrénie; Troubles bipolaires; Unitary psychosis; Épisode mixte