title: An update on the treatment of mixed bipolar states: what is new in 2013?
abstract: Although common and severe, mixed states are rarely the subject of proper clinical trials. The aim of this paper is to systematically review data published in 2013 on the pharmacological treatment of mixed states.
  
  
  METHODS
  The Medline database was searched for 2013 publications using the following keywords: 'treatment'; 'mixed'; 'bipolar'.
  
  
  RESULTS
  Medline search returned 118 results. Manual inspection of abstracts allowed selecting six papers for further review. The first meta-analysis of the efficacy of second-generation antipsychotics in mixed episodes, published in 2013, showed the efficacy of these agents. Other papers suggested that asenapine and olanzapine were efficacious for mixed episodes, with olanzapine being equally effective in patients with or without substance abuse. Aripiprazole and ziprasidone were reported to be efficacious and safe in treating manic/mixed episodes in children and adolescents. In another trial, Calcitonin was not found to be superior to placebo in treating manic/mixed episodes.
  
  
  CONCLUSIONS
  Although data suggest that most agents efficacious for mania may also be efficacious for mixed episodes, further studies are needed to confirm this assumption.
authors.affiliation: Department of Psychiatry E, Razi Hospital, Manouba, Tunisia. Electronic address: sami.ouanes@gmail.com.
authors.forename: Sami
authors.initials: S
authors.lastname: Ouanes
authors.affiliation: Department of Psychiatry E, Razi Hospital, Manouba, Tunisia.
authors.forename: Leila
authors.initials: L
authors.lastname: Chennoufi
authors.affiliation: Department of Psychiatry E, Razi Hospital, Manouba, Tunisia.
authors.forename: Majda
authors.initials: M
authors.lastname: Cheour
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology*; D002116:Calcitonin / Q000009:adverse effects / Q000627:therapeutic use; D003986:Dibenzocycloheptenes; D006576:Heterocyclic Compounds, 4 or More Rings / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D000077152:Olanzapine; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D015363:Quinolones / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003986:Dibenzocycloheptenes; D006576:Heterocyclic Compounds, 4 or More Rings; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D001569:Benzodiazepines; C092292:ziprasidone; D000068180:Aripiprazole; D002116:Calcitonin; C522667:asenapine; D000077152:Olanzapine
keywords: Bipolar disorder; Mixed episode; Mixed state; Treatment