title: [Antimanic treatments in bipolar mixed states].
abstract: BACKGROUND
  Mixed states present nosologic and diagnostic challenges with a relative paucity of evidence to guide treatment. Mixed bipolar states are difficult to treat and are associated with a high neuropsychiatric morbidity, a high risk of suicide and a poor outcome. In DSM- 5, the definition of mixed episode has been removed (in DSM- IV TR: "juxtaposed full manic and depressive episodes"). Mixed symptoms are captured under a broader concept called "mixed features" that is applied to mania and depression. The classification of mixed states as defined in DSM- 5 is less restrictive than in DSM- IV TR and challenges us at methodological and therapeutic levels.
  
  
  OBJECTIVE
  The aim of this paper was to conduct an overview of the literature to ascertain the efficacy of pharmacotherapy of mixed states.
  
  
  METHODS
  A systematic review of the literature was conducted using PubMed.
  
  
  RESULTS
  Manic symptoms of mixed episodes seem to show a good response to second generation antipsychotics and to divalproate. There is no evidence of differential efficacy for second generation of antipsychotics (SGAs). Lithium and carbamazepine may be effective in mixed states in monotherapy and perhaps benefit in combination with SGAs as second line. Combination pharmacological treatment of SGAs and moodstabilizers are common in mixed states. This pattern has the best literature evidence.
  
  
  CONCLUSIONS
  There is a few evidence to help us to choose the right treatment for patients with mixed state. In light with the DSM 5, more drugs specifically designed to treat mixed state are needed.
authors.affiliation: Pôle de psychiatrie centre, Hôpital de La Conception, Boulevard Baille, 13006 Marseille, France. Electronic address: daniel.dassa@ap-hm.fr.
authors.forename: D
authors.initials: D
authors.lastname: Dassa
authors.affiliation: Pôle de psychiatrie centre, Hôpital de La Conception, Boulevard Baille, 13006 Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Dubois
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: E
authors.initials: E
authors.lastname: Fakra
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, Solaris, Hôpital Sainte- Marguerite, 13274 Marseille cedex 09, France.
authors.forename: R
authors.initials: R
authors.lastname: Belzeaux
authors.affiliation: Pôle de psychiatrie des adultes, CHU Robert- Debré, Avenue du Général- Koenig, 51092 Reims cedex,France.
authors.forename: A
authors.initials: A
authors.lastname: Kaladjian
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: J-M
authors.initials: JM
authors.lastname: Azorin
mesh_terms: D000339:Affect / Q000187:drug effects*; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D003131:Combined Modality Therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004565:Electroconvulsive Therapy; D006801:Humans; D018020:Lithium Compounds / Q000009:adverse effects / Q000627:therapeutic use; D013405:Suicide / Q000523:psychology; D000092864:Suicide Prevention
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds
keywords: Antipsychotics; Antipsychotiques; Bipolar disorder; Electroconvulsive therapy; Electroconvulsivothérapie; Mixed state; Mood stabilizers; Normothymiques; Troubles bipolaires; État mixte