title: Mixed States: a "new" nosographic entity.
abstract: OBJECTIVE
  Mixed states represent a controversial topic in the current psychiatry. The definitions and the diagnostic criteria have changed over the past years. The new DSM-5 classification will have a substantial impact in several fields: epidemiology, diagnosis, treatment, research, education, and regulations.
  
  
  METHODS
  We reviewed the latest literature by using the key words "mixed states" and "agitated depression" on the PubMed.
  
  
  RESULTS
  Although there is a great expectation about the validity of the new DSM-5 mixed states diagnosis, little is known about its application on large population study but the formulation of less restrictive and more specific criteria for the diagnosis of mixed states represent a starting point for future researches, mainly in consideration of the fact that previous classifications consider the MS a superposition of manic and depressive symptoms, underestimating the clinical complexity and the wider phenomenologic variability of these conditions.
  
  
  CONCLUSIONS
  Clinical trials need to address treatment effects according to the presence or absence of mixed features in consideration of the fact that replacing in the bipolar spectrum patients that traditionally are considered to be affected by unipolar depression, represent a topical research hypothesis and has a practical remarkable importance in the appropriate therapeutic choice.
authors.affiliation: School of Specialization in Psychiatry, Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy, norma.verdolini@libero.it.
authors.forename: Norma
authors.initials: N
authors.lastname: Verdolini
authors.forename: Mark
authors.initials: M
authors.lastname: Agius
authors.forename: Roberto
authors.initials: R
authors.lastname: Quartesan
authors.forename: Sandro
authors.initials: S
authors.lastname: Elisei