title: The State of the Art of the DSM-5 "with Mixed Features" Specifier.
abstract: The new DSM-5 "with mixed features" specifier (MFS) has renewed the interest of the scientific community in mixed states, leading not only to new clinical studies but also to new criticisms of the current nosology. Consequently, in our paper we have reviewed the latest literature, trying to understand the reactions of psychiatrists to the new nosology and its epidemiological, prognostic, and clinical consequences. It seems that the most widespread major criticism is the exclusion from the DSM-5 MFS of overlapping symptoms (such as psychomotor agitation, irritability, and distractibility), with a consequent reduction in diagnostic power. On the other hand, undoubtedly the new DSM-5 classification has helped to identify more patients suffering from a mixed state by broadening the narrow DSM-IV-TR criteria. As for the clinical presentation, the epidemiological data, and the therapeutic outcomes, the latest literature does not point out a univocal point of view and further research is needed to fully assess the implications of the new DSM-5 MFS. It is our view that a diagnostic category should be preferred to a specifier and mixed states should be better considered as a spectrum of states, according to what was stated many years ago by Kraepelin.
authors.affiliation: School of Specialization in Psychiatry, Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Piazzale Lucio Severi 1, Edificio A, 06132 Perugia, Italy ; Santa Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: Norma
authors.initials: N
authors.lastname: Verdolini
authors.affiliation: Department of Psychiatry, East London Partnership Foundation Trust, Bedfordshire Centre for Mental Health Research in Association with the University of Cambridge, University of Cambridge, Charter House, Alma Street, Luton LU1 2PJ, UK ; Clare College Cambridge, The University of Cambridge, Cambridge, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Agius
authors.affiliation: Biotechnologies and Biomaterials in Vascular and Metabolic-Endocrine Diseases, University of Perugia, Piazzale Lucio Severi 1, Edificio A, 06132 Perugia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ferranti
authors.affiliation: Santa Maria della Misericordia Hospital, Perugia, Italy ; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Piazzale Lucio Severi 1, Edificio A, 06132 Perugia, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Moretti
authors.affiliation: Functional Area of Psychiatry, University of Perugia, Piazzale Lucio Severi 1, Edificio A, 06132 Perugia, Italy ; AUSL Umbria 2, Servizio Psichiatrico Diagnosi e Cura, Ospedale S. Giovanni Battista, Via Massimo Arcamone, 06034 Foligno, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Piselli
authors.affiliation: Santa Maria della Misericordia Hospital, Perugia, Italy ; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Piazzale Lucio Severi 1, Edificio A, 06132 Perugia, Italy ; Functional Area of Psychiatry, University of Perugia, Piazzale Lucio Severi 1, Edificio A, 06132 Perugia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Quartesan
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D007508:Irritable Mood; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000503:physiopathology; D009626:Terminology as Topic