19. Diagnosis and Treatment of Mixed States

  1. Hagop S. Akiskal2 and
  2. Mauricio Tohen3
  1. Alan C. Swann

Published Online: 13 APR 2011

DOI: 10.1002/9780470975114.ch19

Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition

Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition

How to Cite

Swann, A. C. (2011) Diagnosis and Treatment of Mixed States, in Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition (eds H. S. Akiskal and M. Tohen), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470975114.ch19

Editor Information

  1. 2

    International Mood Center, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0603, USA

  2. 3

    Department of Psychiatry, Division of Mood and Anxiety Disorders, University of Texas Health Science Centre at San Antonio, 7730 Floyd Curl Drive, San Antonio, TX 78229, USA

Author Information

  1. Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1300 Moursund Street, Houston TX 77030, USA

Publication History

  1. Published Online: 13 APR 2011
  2. Published Print: 15 APR 2011

ISBN Information

Print ISBN: 9780470747216

Online ISBN: 9780470975114

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Keywords:

  • Diagnosis and Treatment of Mixed States;
  • Predominately Manic;
  • Predominately Depressive;
  • Lithium in Mixed Manic States;
  • Antidepressive Agents

Summary

Mixed states are a severe manifestation of bipolar disorder, where components of depressive and manic states occur in the same episode. While DSM-IV defines mixed states as manic episodes combined with full syndromal major depressive illness, mixed states can be predominately depressive or manic. Predominately manic or depressive mixed states share similar characteristics with respect to course of illness, and clinical presentation, and these characteristics emerge at subsyndromal levels of mixed symptoms. Therefore, there appears to be a continuum of mixed states across depression, and mania. Mixed episodes combine depression and activation, leading to susceptibility to suicidal behavior and other severe behavioral disturbances. Patients with mixed states have a severe course of illness, including early onset, frequent episodes, psychiatric and medical comorbidities, and suicidal behavior. Mixed states can be difficult to treat and are likely to require more pharmacological agents than non-mixed states. Successful treatment, based on agents with mood-stabilizing properties, requires a vigorous approach to the severe underlying illness.