Dysphoric mania, mixed states, and mania with mixed features specifier: are we mixing things up?

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 170-176 ◽  
Author(s):  
Susan L. McElroy ◽  
Paul E. Keck
Keyword(s):  
Depressive Symptoms ◽  
Mixed State ◽  
Mixed States ◽  
Mixed Features

Various terms have been used to describe mania when it is accompanied by depressive symptoms. In this article, we attempt to define and discuss 3 of these terms: dysphoric mania, mixed state, and mania with mixed features specifier. We conclude that whatever term is used, it is important to be aware that mania is more often unpleasant than pleasant, and that the unpleasantness is not limited to depression.

Treating mixed mania/hypomania: a review and synthesis of the evidence

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 177-185 ◽  
Author(s):  
Minoru Takeshima
Keyword(s):  
Depressive Symptoms ◽  
Acute Phase ◽  
Opposite Polarity ◽  
Mood Stabilizers ◽  
Current Evidence ◽  
Mixed States ◽  
Mixed Features ◽  
Broad Concept ◽  
Major Depressive Episodes ◽  
Depressive Episodes

The DSM–5 incorporates a broad concept of mixed states and captured ≥3 nonoverlapping symptoms of the opposite polarity using a “with mixed features” specifier to be applied to manic/hypomanic and major depressive episodes. Pharmacotherapy of mixed states is challenging because of the necessity to treat both manic/hypomanic and depressive symptoms concurrently. High-potency antipsychotics used to treat manic symptoms and antidepressants can potentially deteriorate symptoms of the opposite polarity. This review aimed to provide a synthesis of the current evidence for pharmacotherapy of mixed states with an emphasis on mixed mania/hypomania. A PubMed search was conducted for randomized controlled trials (RCTs) that were at least moderately sized, included a placebo arm, and contained information on acute-phase and maintenance treatments of adult patients with mixed episodes or mania/hypomania with significant depressive symptoms. Most studies were post-hoc subgroup and pooled analyses of the data from RCTs for acute manic and mixed episodes of bipolar I disorder; only two prospectively examined efficacy for mixed mania/hypomania specifically. Aripiprazole, asenapine, carbamazepine, olanzapine, and ziprasidone showed the strongest evidence of efficacy in acute-phase treatment. Quetiapine and divalproex/valproate were also efficacious. Combination therapies with these atypical antipsychotics and mood stabilizers can be considered in severe cases. Olanzapine and quetiapine (alone or in combination with lithium/divalproex) showed the strongest evidence of efficacy in maintenance treatment. Lithium and lamotrigine may be beneficial given their preventive effects on suicide and depressive relapse. Further prospective studies primarily focusing on mixed states are needed.

The treatment of mixed states and the risk of switching to depression

2005 ◽  
Vol 20 (2) ◽  
pp. 96-100 ◽  
Author(s):  
Eduard Vieta
Keyword(s):  
Clinical Trials ◽  
Depressive Symptoms ◽  
Mixed State ◽  
Atypical Antipsychotics ◽  
Randomized Clinical Trials ◽  
Mixed States ◽  
Conventional Antipsychotics

AbstractThere are few controlled studies evaluating the treatment of bipolar mixed states. Evidence suggests that mixed states may be more responsive to some anticonvulsants than to lithium. Olanzapine alone or in combination with divalproate or lithium has been adequately evaluated in randomized clinical trials involving mixed-state patients, whereas risperidone and quetiapine have not. There is also some evidence demonstrating the efficacy of ziprasidone and aripiprazole. The risk of switching to depression is high in mixed states. Conventional antipsychotics, such as haloperidol, may be less efficacious at protecting against a switch to depression than atypical antipsychotics, divalproate or lithium. When choosing drugs for the treatment of mania, and especially for the treatment of mixed states, their efficacy against manic and depressive symptoms, and their safety in terms of the risk of switching to depression should be taken into account.

scholarly journals Efficacy of Electroconvulsive Therapy in Bipolar Disorder with Mixed Features

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Miguel Palma ◽  
Berta Ferreira ◽  
Nuno Borja-Santos ◽  
Bruno Trancas ◽  
Céu Monteiro ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mixed State ◽  
Affective State ◽  
Time Frame ◽  
Mixed States ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Mixed Features ◽  
Maintenance Ect ◽  
Bipolar Patients

Introduction.Mixed states represent a frequent presentation of bipolar disorder, associated with higher resistance to psychopharmacology. Limited evidence supports the use of ECT in these patients. We aim to report our experience on treating bipolar mixed states with ECT.Methods.Retrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2006 and June 2011. Three groups were created in terms of affective polarity of the episode. CGI rating was used to establish clinical remission and demographic and clinical variables were compared among groups. Long-term outcome was assessed through readmission measures, considering the use of continuation or maintenance ECT.Results.During the study time frame, a total of 50 ECT course treatments were performed on 41 bipolar patients. All affective episodes, except one mixed state, showed a positive clinical response. Patients with mixed state presentation tended to be younger and have an earlier first hospitalization than depressed patients. No differences were found in terms of ECT sessions performed, length of hospital admission, referral to continuation ECT treatment, number of readmissions, and time until next readmission.Conclusions.Our results support the effectiveness of ECT in patients experiencing a mixed affective state.

scholarly journals Not Only Mania or Depression: Mixed States/Mixed Features in Paediatric Bipolar Disorders

2021 ◽  
Vol 11 (4) ◽  
pp. 434
Author(s):  
Delfina Janiri ◽  
Eliana Conte ◽  
Ilaria De Luca ◽  
Maria Velia Simone ◽  
Lorenzo Moccia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bipolar Disorders ◽  
Prevalence Rates ◽  
Mixed States ◽  
Total Patient ◽  
Hyperactivity Disorder ◽  
Mixed Features ◽  
Paediatric Age ◽  
Meta Analyses ◽  
The Relationship

Background: early onset is frequent in Bipolar Disorders (BDs), and it is characterised by the occurrence of mixed states (or mixed features). In this systematic review, we aimed to confirm and extend these observations by providing the prevalence rates of mixed states/features and data on associated clinical, pharmacological and psychopathological features. Methods: following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched from inception to 9 February 2021 for all studies investigating mixed states/mixed features in paediatric BD. Data were independently extracted by multiple observers. The prevalence rates of mixed states/features for each study were calculated. Results: eleven studies were included in our review, involving a total patient population of 1365 individuals. Overall, of the patients with paediatric age BD, 55.2% had mixed states/features (95% CI 40.1–70.3). Children with mixed states/features presented with high rates of comorbidities, in particular, with Attention Deficit Hyperactivity Disorder (ADHD). Evidences regarding the psychopathology and treatment response of mixed states/features are currently insufficient. Conclusions: our findings suggested that mixed states/features are extremely frequent in children and adolescents with BD and are characterised by high levels of comorbidity. Future investigations should focus on the relationship between mixed states/features and psychopathological dimensions as well as on the response to pharmacological treatment.

Measures of the DSM–5 mixed-features specifier of major depressive disorder

CNS Spectrums ◽  
2017 ◽  
Vol 22 (2) ◽  
pp. 196-202 ◽  
Author(s):  
Mark Zimmerman
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Antidepressant Medication ◽  
Reliability And Validity ◽  
Mixed States ◽  
Major Depressive ◽  
Manic Symptoms ◽  
Dsm 5 ◽  
Depressed Patients ◽  
Mixed Features

During the past two decades, a number of studies have found that depressed patients frequently have manic symptoms intermixed with depressive symptoms. While the frequency of mixed syndromes are more common in bipolar than in unipolar depressives, mixed states are also common in patients with major depressive disorder. The admixture of symptoms may be evident when depressed patients present for treatment, or they may emerge during ongoing treatment. In some patients, treatment with antidepressant medication might precipitate the emergence of mixed states. It would therefore be useful to systematically inquire into the presence of manic/hypomanic symptoms in depressed patients. We can anticipate that increased attention will likely be given to mixed depression because of changes in the DSM–5. In the present article, I review instruments that have been utilized to assess the presence and severity of manic symptoms and therefore could be potentially used to identify the DSM–5 mixed-features specifier in depressed patients and to evaluate the course and outcome of treatment. In choosing which measure to use, clinicians and researchers should consider whether the measure assesses both depression and mania/hypomania, assesses all or only some of the DSM–5 criteria for the mixed-features specifier, or assesses manic/hypomanic symptoms that are not part of the DSM–5 definition. Feasibility, more so than reliability and validity, will likely determine whether these measures are incorporated into routine clinical practice.

scholarly journals Rethinking the spectrum of mood disorders: implications for diagnosis and management – Proceedings of a symposium presented at the 30th Annual European College of Neuropsychopharmacology Congress, 4 September 2017, Paris, France

2018 ◽  
Vol 8 (1_suppl) ◽  
pp. 1-16 ◽  
Author(s):  
Roger S. McIntyre ◽  
Allan H. Young ◽  
Peter M. Haddad
Keyword(s):  
Controlled Trial ◽  
Treatment Options ◽  
Current Evidence ◽  
Simultaneous Occurrence ◽  
Affective States ◽  
Mixed States ◽  
Course Of Illness ◽  
Dsm 5 ◽  
Opposite Pole ◽  
Mixed Features

The simultaneous occurrence of manic and depressive features has been recognized since classical times, but the term ‘mixed state’ was first used by Kraepelin at the end of the 19th century. From the 1980s, until the advent of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), psychiatric disorders were classified using a categorical approach. However, it was recognized that such an approach was too rigid to encompass the range of symptomatology encountered in clinical practice. Therefore, a dimensional approach was adopted in DSM-5, in which affective states are considered to be distributed across a continuum ranging from pure mania to pure depression. In addition, the copresence of symptoms of the opposite pole are captured using a ‘with mixed features’ specifier, applied when three or more nonoverlapping subthreshold symptoms of the opposite pole are present. Mixed features are common in patients with mood episodes, complicating the course of illness, reducing treatment response and worsening outcomes. However, research in this area is scarce and treatment options are limited. Current evidence indicates that antidepressants should be avoided for the treatment of bipolar mixed states. Evidence for bipolar mixed states supports the use of several second-generation antipsychotics, valproate and electroconvulsive therapy. One randomized controlled trial has demonstrated the efficacy of lurasidone, compared with placebo, in patients with major depressive disorder with mixed features, and there is limited evidence supporting the use of ziprasidone in such patients. Further research is required to determine whether other antipsychotic agents, or additional therapeutic approaches, might also be effective in this setting.

scholarly journals Virtual Correlations in Single Qutrit

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Alexey A. Strakhov ◽  
Vladimir I. Man’ko
Keyword(s):  
Mixed State ◽  
Three Dimensional ◽  
Mixed States ◽  
One To One

We construct the positive invertible map of the mixed states of a single qutrit onto the antisymmetrized bipartite qutrit states (quasifermions). It is shown that using this one-to-one correspondence between qutrit states and states of two three-dimensional quasifermions one may attribute hidden entanglement to a single mixed state of qutrit.

scholarly journals Bounds on Mixed State Entanglement

Entropy ◽  
2020 ◽  
Vol 22 (1) ◽  
pp. 62 ◽  
Author(s):  
Bruno Leggio ◽  
Anna Napoli ◽  
Hiromichi Nakazato ◽  
Antonino Messina
Keyword(s):  
Mixed State ◽  
General Framework ◽  
Quantum Correlations ◽  
Thermal Entanglement ◽  
Mixed States ◽  
Clear Explanation ◽  
Finite Dimensionality ◽  
Partial Transpose ◽  
The Subject

In the general framework of d 1 × d 2 mixed states, we derive an explicit bound for bipartite negative partial transpose (NPT) entanglement based on the mixedness characterization of the physical system. The derived result is very general, being based only on the assumption of finite dimensionality. In addition, it turns out to be of experimental interest since some purity-measuring protocols are known. Exploiting the bound in the particular case of thermal entanglement, a way to connect thermodynamic features to the monogamy of quantum correlations is suggested, and some recent results on the subject are given a physically clear explanation.

GEOMETRIC PHASES OF PURE AND MIXED STATES

COSMOS ◽  
2006 ◽  
Vol 02 (01) ◽  
pp. 81-100
Author(s):  
R. RAVISHANKAR ◽  
J. F. DU
Keyword(s):  
Experimental Measurement ◽  
Mixed State ◽  
Geometric Phase ◽  
Mixed States ◽  
Geometric Phases

The purpose of this article is to review the literature for pure and mixed state geometric phase and also the experimental measurement of the phase using NMR.

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