title: The significance of mixed states in depression and mania.
abstract: The DSM-5 definition of mixed features "specifier" of manic, hypomanic and major depressive episodes captures sub-syndromal non-overlapping symptoms of the opposite pole, experienced in bipolar (I, II, and not otherwise specified) and major depressive disorders. This combinatory model seems to be more appropriate for less severe forms of mixed state, in which mood symptoms are prominent and clearly identifiable. Sub-syndromal depressive symptoms have been frequently reported to co-occur during mania. Similarly, manic or hypomanic symptoms during depression resulted common, dimensionally distributed, and recurrent. The presence of mixed features has been associated with a worse clinical course and high rates of comorbidities including anxiety, personality, alcohol and substance use disorders and head trauma or other neurological problems. Finally, mixed states represent a major therapeutic challenge, especially when you consider that these forms tend to have a less favorable response to drug treatments and require a more complex approach than non-mixed forms.
authors.affiliation: Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy, giulio.perugi@med.unipi.it.
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Quaranta
authors.forename: Liliana
authors.initials: L
authors.lastname: Dell'Osso
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004565:Electroconvulsive Therapy; D006801:Humans
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents