scholarly journals The prevalence and diagnostic classification of mixed features in patients with major depressive episodes: A multicenter study based on the DSM‐5

2019 ◽  
Vol 28 (3) ◽  
Author(s):  
In Hee Shim ◽  
Jonghun Lee ◽  
Moon‐Doo Kim ◽  
Young‐Eun Jung ◽  
Kyung Joon Min ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Diagnostic Classification ◽  
Major Depressive ◽  
Dsm 5 ◽  
Mixed Features ◽  
Major Depressive Episodes ◽  
Depressive Episodes

What is the role of conventional antidepressants in the treatment of major depressive episodes with Mixed Features Specifier?

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Gianni L. Faedda ◽  
Ciro Marangoni
Keyword(s):  
Clinical Trials ◽  
Unipolar Depression ◽  
Preliminary Evidence ◽  
Major Depressive ◽  
Pharmacological Management ◽  
Diagnostic And Statistical Manual ◽  
Mixed Features ◽  
Effective Use ◽  
Major Depressive Episodes ◽  
Depressive Episodes

The newly introduced Mixed Features Specifier of Major Depressive Episode and Disorder (MDE/MDD) is especially challenging in terms of pharmacological management. Prior to the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the symptoms of the mixed features specifier were intradepressive hypomanic symptoms, always and only associated with bipolar disorder (BD).Intradepressive hypomanic symptoms, mostly referred to as depressive mixed states (DMX), have been poorly characterized, and their treatment offers significant challenges. To understand the diagnostic context of DMX, we trace the nosological changes and collocation of intradepressive hypomanic symptoms, and examine diagnostic and prognostic implications of such mixed features.One of the reasons so little is known about the treatment of DMX is that depressed patients with rapid cycling, substance abuse disorder, and suicidal ideation/attempts are routinely excluded from clinical trials of antidepressants. The exclusion of DMX patients from clinical trials has prevented an assessment of the safety and tolerability of short- and long-term use of antidepressants. Therefore, the generalization of data obtained in clinical trials for unipolar depression to patients with intradepressive hypomanic features is inappropriate and methodologically flawed.A selective review of the literature shows that antidepressants alone have limited efficacy in DMX, but they have the potential to induce, maintain, or worsen mixed features during depressive episodes in BD. On the other hand, preliminary evidence supports the effective use of some atypical antipsychotics in the treatment of DMX.

Stahl's Essential Psychopharmacology

2021 ◽  
Author(s):  
Stephen M. Stahl
Keyword(s):  
Mental Health Professionals ◽  
Health Professionals ◽  
Visual Language ◽  
New Drugs ◽  
Major Depressive ◽  
Mixed Features ◽  
Color Scheme ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Source Of Information

Long established as the preeminent source in its field, the eagerly anticipated fifth edition of Dr Stahl's essential textbook of psychopharmacology is here! With its use of icons and figures that form Dr Stahl's unique 'visual language', the book is the single most readable source of information on disease and drug mechanisms for all students and mental health professionals seeking to understand and utilize current therapeutics, and to anticipate the future for novel medications. Every aspect of the book has been updated, with the clarity of explanation that only Dr Stahl can bring. The new edition includes over 500 new or refreshed figures, an intuitive color scheme, fourteen new uses for older drugs and eighteen brand new drugs, coverage of Parkinson's Disease Psychosis, behavioural symptoms of dementia, and mixed features in major depressive episodes, and expanded information on the medical uses of cannabis and hallucinogen assisted psychotherapy.

Treatment of mixed features in bipolar disorder

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Joshua D. Rosenblat ◽  
Roger S. McIntyre
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Treatment Resistance ◽  
Course Of Illness ◽  
Stabilizing Agents ◽  
Dsm 5 ◽  
Mixed Features ◽  
Post Hoc ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Mood episodes with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)–defined mixed features are highly prevalent in bipolar disorder (BD), affecting ~40% of patients during the course of illness. Mixed states are associated with poorer clinical outcomes, greater treatment resistance, higher rates of comorbidity, more frequent mood episodes, and increased rates of suicide. The objectives of the current review are to identify, summarize, and synthesize studies assessing the efficacy of treatments specifically for BD I and II mood episodes (ie, including manic, hypomanic, and major depressive episodes) with DSM-5–defined mixed features. Two randomized controlled trials (RCTs) and 6 post-hoc analyses were identified, all of which assessed the efficacy of second-generation antipsychotics (SGAs) for the acute treatment of BD mood episodes with mixed features. Results from these studies provide preliminary support for SGAs as efficacious treatments for both mania with mixed features and bipolar depression with mixed features. However, there are inadequate data to definitively support or refute the clinical use of specific agents. Conventional mood stabilizing agents (eg, lithium and divalproex) have yet to have been adequately studied in DSM-5–defined mixed features. Further study is required to assess the efficacy, safety, and tolerability of treatments specifically for BD mood episodes with mixed features.

The treatment of bipolar mixed states

2017 ◽  
Author(s):  
Sarah Kittel-Schneider
Keyword(s):  
Mixed States ◽  
Major Depressive ◽  
Randomized Controlled Clinical Trials ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Bipolar Ii ◽  
Definition Of ◽  
Bipolar Patients ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Definition of mixed episodes has changed in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5). A mixed feature specifier can be added not only to major depressive episodes and manic episodes in bipolar patients but also to hypomanic episodes in bipolar II patients and major depressive episode in major depressive disorder. Atypical antipsychotics seem to be effective in acute treatment as well as valproate and carbamazepine. Regarding prophylaxis of mixed states, monotherapy with valproate, olanzapine and quetiapine seems to prevent mixed episodes. Adjunctive therapy with valproate or lithium to quetiapine has also proven to be effective in prophylaxis of mixed episodes. In patients who suffer from pharmacotherapy-resistant mixed episodes electroconvulsive therapy can lead to response/remission. There is a lack of randomized controlled clinical trials investigating pharmacological and non-pharmacological treatments with focus on mixed states of bipolar patients, especially according to the DSM-5 definition.

scholarly journals Clinical Features of A Depressive Episode in People Who Had and Haven’t Had Covid-19

2021 ◽  
Vol 4 (2) ◽  
Keyword(s):  
Clinical Features ◽  
Depressive Episode ◽  
Rating Scale ◽  
Visual Hallucinations ◽  
Major Depressive ◽  
Dsm 5 ◽  
The One ◽  
Anxiety Depression ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Objective: In publications, indicate increased anxiety, depression, and aggression of other mental disorders. The literature on psychiatric disorders associated with the depressive episode in people who had COVID-19. However, there are practically is not study clinical features of a depressive episode in people who had and haven’t had COVID-19. Materials and Methods: Eligible 100 participants all women to meeting the DSM-5 criteria, Hamilton Depression Rating Scale and PHQ-9 for depressive episode. Results: Patients who had a depressive episode after the COVID-19 disease were clinically different from those who had had major depressive episodes before COVID-19. On the one hand, this was expressed as a share in the fact that, in the clinical picture of a depressive episode manifested after the COVID-19 disease, visual hallucinations of various contents were encountered. On the other hand, patients who could not tolerate COVID-19, the presence of a pandemic exacerbated the onset of a depressive episode. Conclusion: Clinical features of a depressive episode in people who had and haven’t had COVID-19 dramatically differ from each other. Accordingly, therapy for these conditions is recommended.

scholarly journals Mixed-up about how to diagnose and treat mixed features in major depressive episodes

CNS Spectrums ◽  
2017 ◽  
Vol 22 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Stephen M. Stahl
Keyword(s):  
Clinical Outcome ◽  
Point Of View ◽  
Line Treatment ◽  
First Line ◽  
Major Depressive ◽  
Mixed Features ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Classical Point ◽  
First Line Treatment

The classical point of view—that major depressive episodes (MDEs), no matter what additional symptoms are present, should be treated first line with antidepressants—is now giving way to new a notion. The idea is that MDEs mixed with a few symptoms of mania/hypomania should be viewed very differently in terms of their natural history, clinical outcome, and treatment, and perhaps certain antipsychotics should be given as first-line treatment rather than antidepressant monotherapy.

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