title: [Mixed states: evolution of classifications].
abstract: The nosological position of mixed states has followed the course of classifying methods in psychiatry, the steps of the invention of the clinic, progress in the organization of care, including the discoveries of psychopharmacology. The clinical observation of a mixture of symptoms emerging from usually opposite clinical conditions is classical. In the 70s, a syndromic specification fixed the main symptom combinations but that incongruous assortment failed to stabilize the nosological concept. Then stricter criteriology was proposed. To be too restrictive, a consensus operates a dimensional opening that attempts to meet the pragmatic requirements of nosology validating the usefulness of the class system. This alternation between rigor of categorization and return to a more flexible criteriological option reflects the search for the right balance between nosology and diagnosis. The definition of mixed states is best determined by their clinical and prognostic severity, related to the risk of suicide, their lower therapeutic response, the importance of their psychiatric comorbidities, anxiety, emotional lability, alcohol abuse. Trying to compensate for the lack of categorical definitions and better reflecting the clinical field problems, new definitions complement criteriology with dimensional aspects, particularly taking into account temperaments.
authors.affiliation: Clinique de psychiatrie et de psychologie médicale, CHU Pasteur, 06002 Nice Cedex, France. Electronic address: pringuey.d@chu-nice.fr.
authors.forename: D
authors.initials: D
authors.lastname: Pringuey
authors.affiliation: Clinique de psychiatrie et de psychologie médicale, CHU Pasteur, 06002 Nice Cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Cherikh
authors.affiliation: Clinique de psychiatrie et de psychologie médicale, CHU Pasteur, 06002 Nice Cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Giordana
authors.affiliation: SHU psychiatrie adultes - pavillon Solaris, Hôpital Sainte-Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: E
authors.initials: E
authors.lastname: Fakra
authors.affiliation: Pôle de psychiatrie centre, Hôpital de La Conception, boulevard Baille, 13006 Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Dassa
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: R
authors.initials: R
authors.lastname: Belzeaux
authors.affiliation: SHU psychiatrie adultes - pavillon Solaris, Hôpital Sainte-Marguerite, 13274 Marseille Cedex 09, France.
authors.forename: M
authors.initials: M
authors.lastname: Maurel
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: D000342:Affective Symptoms / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D000437:Alcoholism / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D035843:Biomedical Research; D001714:Bipolar Disorder / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D003937:Diagnosis, Differential; D006801:Humans; D011379:Prognosis; D012559:Schizophrenia / Q000145:classification* / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D013405:Suicide / Q000523:psychology; D013694:Temperament
keywords: Diagnosis; Diagnostic; Mixed States; Nosologie; Nosology; Structure; États mixtes