scholarly journals Mixed states in bipolar disorder: modelling, measuring and managing

2018 ◽  
Vol 27 (1) ◽  
pp. 69-71 ◽  
Author(s):  
Gordon Parker ◽  
Tahlia Ricciardi
Keyword(s):  
Bipolar Disorder ◽  
Treatment Guidelines ◽  
Antidepressant Medication ◽  
Mixed States ◽  
Limited Evidence ◽  
Best Management ◽  
Dsm 5 ◽  
Dsm Iv ◽  
Second Generation Antipsychotic ◽  
Definition Of

Objective: To consider whether consensus exists in recommendations for managing bipolar mixed states published in recent reviews and treatment guidelines, and to summarise what might be their best management. Conclusion: Limitations to and changes in the definition of mixed states compromise diagnosis and management. The striking comparison between DSM-IV and DSM-5 criteria sets risks under-diagnosis and over-diagnosis. Current reviews and guidelines offer limited evidence to guide treatment; however, management should involve addressing the contribution of any antidepressant medication, and the introduction of a second-generation antipsychotic medication to stabilise the condition.

scholarly journals Guidelines for the recognition and management of mixed depression

CNS Spectrums ◽  
2017 ◽  
Vol 22 (2) ◽  
pp. 203-219 ◽  
Author(s):  
Stephen M. Stahl ◽  
Debbi A. Morrissette ◽  
Gianni Faedda ◽  
Maurizio Fava ◽  
Joseph F. Goldberg ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Threshold Level ◽  
Current Treatment ◽  
Mixed States ◽  
Manic Symptoms ◽  
Mixed Features ◽  
Nosological Entity ◽  
Dsm Iv ◽  
Definition Of ◽  
Threshold Criteria

A significant minority of people presenting with a major depressive episode (MDE) experience co-occurring subsyndromal hypo/manic symptoms. As this presentation may have important prognostic and treatment implications, the DSM–5 codified a new nosological entity, the “mixed features specifier,” referring to individuals meeting threshold criteria for an MDE and subthreshold symptoms of (hypo)mania or to individuals with syndromal mania and subthreshold depressive symptoms. The mixed features specifier adds to a growing list of monikers that have been put forward to describe phenotypes characterized by the admixture of depressive and hypomanic symptoms (e.g., mixed depression, depression with mixed features, or depressive mixed states [DMX]). Current treatment guidelines, regulatory approvals, as well the current evidentiary base provide insufficient decision support to practitioners who provide care to individuals presenting with an MDE with mixed features. In addition, all existing psychotropic agents evaluated in mixed patients have largely been confined to patient populations meeting the DSM–IV definition of “mixed states” wherein the co-occurrence of threshold-level mania and threshold-level MDE was required. Toward the aim of assisting clinicians providing care to adults with MDE and mixed features, we have assembled a panel of experts on mood disorders to develop these guidelines on the recognition and treatment of mixed depression, based on the few studies that have focused specifically on DMX as well as decades of cumulated clinical experience.

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.

To ID or Not to ID? Changes in Classification Rates of Intellectual Disability Using DSM-5

2014 ◽  
Vol 52 (3) ◽  
pp. 165-174 ◽  
Author(s):  
Aimilia Papazoglou ◽  
Lisa A. Jacobson ◽  
Marie McCabe ◽  
Walter Kaufmann ◽  
T. Andrew Zabel
Keyword(s):  
Intellectual Disability ◽  
Clinical Judgment ◽  
Assessment System ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Adaptive Behavior Assessment System ◽  
Dsm Iv ◽  
Definition Of ◽  
Adaptive Skill

Abstract The Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5) diagnostic criteria for intellectual disability (ID) include a change to the definition of adaptive impairment. New criteria require impairment in one adaptive domain rather than two or more skill areas. The authors examined the diagnostic implications of using a popular adaptive skill inventory, the Adaptive Behavior Assessment System–Second Edition, with 884 clinically referred children (ages 6–16). One hundred sixty-six children met DSM-IV-TR criteria for ID; significantly fewer (n  =  151, p  =  .001) met ID criteria under DSM-5 (9% decrease). Implementation of DSM-5 criteria for ID may substantively change the rate of ID diagnosis. These findings highlight the need for a combination of psychometric assessment and clinical judgment when implementing the adaptive deficits component of the DSM-5 criteria for ID diagnosis.

Clinical significance, disability, and biomarkers: Shifts in thinking between DSM-IV and DSM-5

2017 ◽  
Author(s):  
Derek Bolton
Keyword(s):  
Mental Disorder ◽  
General Medicine ◽  
External World ◽  
Normal Function ◽  
Dsm 5 ◽  
The Central Nervous System ◽  
Dsm Iv ◽  
Poor Outcomes ◽  
Definition Of ◽  
Made In

Proposals have been made in connection with ICD and DSM revisions to separate the concepts of mental disorder and of impairments in social, occupational, or other important areas of functioning. The proposals are consistent with viewing disability as a social concept rather than a medical one. It is argued here on the basis of two main premises that mental disorder specifically cannot be conceptualized independently of social impairments. The first premise is that in general medicine the definition of disease essentially turns on impairments of normal function of an organ or system leading to poor outcomes. The second, compound premise is that one normal function of the central nervous system is the regulation of behaviour in the external world, and that this function is approximately the domain of the mental. The conclusion is drawn that mental disorder conceptually involves downturn in social, occupational, or other important areas of functioning.

Exclusion of overlapping symptoms in DSM-5 mixed features specifier: heuristic diagnostic and treatment implications

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Gin S Malhi ◽  
Yulisha Byrow ◽  
Tim Outhred ◽  
Kristina Fritz
Keyword(s):  
Future Research ◽  
Mixed States ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Mixed Features ◽  
Definition Of ◽  
Compare And Contrast ◽  
Current Classification System

This article focuses on the controversial decision to exclude the overlapping symptoms of distractibility, irritability, and psychomotor agitation (DIP) with the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) mixed features specifier. In order to understand the placement of mixed states within the current classification system, we first review the evolution of mixed states. Then, using Kraepelin’s original classification of mixed states, we compare and contrast his conceptualization with modern day definitions. The DSM-5 workgroup excluded DIP symptoms, arguing that they lack the ability to differentiate between manic and depressive states; however, accumulating evidence suggests that DIP symptoms may be core features of mixed states. We suggest a return to a Kraepelinian approach to classification—with mood, ideation, and activity as key axes—and reintegration of DIP symptoms as features that are expressed across presentations. An inclusive definition of mixed states is urgently needed to resolve confusion in clinical practice and to redirect future research efforts.

Dimensions of mania: differences between mixed and pure episodes

2004 ◽  
Vol 19 (5) ◽  
pp. 307-310 ◽  
Author(s):  
Ana González-Pinto ◽  
Ana Aldama ◽  
Asunción González Pinto ◽  
Fernando Mosquera ◽  
José Luis Pérez de Heredia ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Clinical Trials ◽  
Depressive Symptoms ◽  
Factorial Analysis ◽  
Mixed States ◽  
Varimax Rotation ◽  
Factor Solution ◽  
Bipolar I Disorder ◽  
Five Dimensions ◽  
Dsm Iv

AbstractObjectiveThe presence of at least five dimensions in mania has recently been established. This study extends previous findings by comparing the dimensions of pure vs. mixed mania.Materials and methodOne hundred and three inpatients with bipolar I disorder, manic or mixed (DSM IV), were assessed with SCID-I, YMRS and HDRS-21. The five-factor solution found after applying factorial analysis with Varimax rotation was compared between manic and mixed patients.ResultsThere were differences between pure mania and mixed states on factor 1 (depression) and factor 3 (hedonism). There was a tendency to present higher values on factor 5 (activation) in the pure manic group. No differences were found in factor 2 (dysphoria) and factor 4 (psychosis).DiscussionHedonism and activation dimensions are present to a lesser degree in mixed states. Although the principal difference between mixed and pure bipolar disorder is the existence of depressive symptoms, the depressive dimension is strongly present in patients with pure mania.ConclusionsThere is need to search for core depressive symptoms in all patients suffering from mania and to evaluate their outcome in clinical trials.

Scope and Characteristics of Suicide Attempts Among Manic Patients With Bipolar Disorder

Crisis ◽  
2018 ◽  
Vol 39 (6) ◽  
pp. 489-492
Author(s):  
Marnina Swartz-Vanetik ◽  
Mark Zeevin ◽  
Yoram Barak
Keyword(s):  
Bipolar Disorder ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Clinical Severity ◽  
Mixed States ◽  
Retrospective Design ◽  
Raising Awareness ◽  
Increased Risk ◽  
Dsm Iv ◽  
Manic Patients

Abstract. Background: Suicide is often associated with depression in patients suffering from bipolar disorder (BD) and less is known about its relation to mania. Available data suggest that patients in the manic phase of BD may be at risk of suicide. Aim: We characterized suicide attempts in a cohort of patients with BD in manic and mixed phases. Method: We focused on the scope, rate, and characteristics of suicide attempts among BD patients during manic or mixed states. Associations between suicide as well as clinical and sociodemographic variables were analyzed using computerized medical chart data from 209 adult inpatients diagnosed (DSM-IV) as experiencing manic and mixed BD episodes. Results: The rate of recent suicide attempts among BD inpatients with manic and mixed episodes was 10.5%. Married patients had a decreased rate of suicide attempts. Comorbid alcohol or substance abuse were correlated with an increased risk of suicide attempts. Presence of suicidal ideation increased suicide risk while older age was linked to a decrease in the rate of suicide attempts. Limitations: The retrospective design of the study and overrepresentation of the clinical severity of BD were limitations. Conclusion: The rate of suicide attempts in the manic and mixed phases of BD is substantial and calls for raising awareness among psychiatrists.

Mood Disorders in ICD-11 and DSM-5

2013 ◽  
Vol 10 (01) ◽  
pp. 24-29 ◽  
Author(s):  
M. Maj
Keyword(s):  
Bipolar Disorder ◽  
Anxiety Disorders ◽  
Mood Disorders ◽  
Unipolar Depression ◽  
Mixed States ◽  
Paper Briefly ◽  
Schizoaffective Disorders ◽  
Dsm 5 ◽  
The Past

SummaryThis paper briefly reviews how the ICD-11 and DSM-5 are going to handle the various continua existing in the area of mood disorders. The two systems will address the continua between “normal” elation and hypomania, between unipolar depression and bipolar disorder, and between anxiety disorders and depression in a more consistent way than in the past, while there will be differences in the characterization of mixed states and schizoaffective disorders. A major weakness of both systems will be the fact that the boundary between “normal” sadness and depression will not be based on a solid empirical evidence.

Defining Depression and Bipolar Disorder

2017 ◽  
pp. 3-44
Author(s):  
Rachel Neuhut ◽  
Tami Benton ◽  
Paul Crits-Christoph ◽  
Marivel Davila ◽  
Myrna Weissman ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Large Scale ◽  
Age Of Onset ◽  
Population Based ◽  
Dsm 5 ◽  
Previous Edition ◽  
Scale Population ◽  
Epidemiology Of Depression ◽  
Definition Of

Chapter 1 reviews the epidemiology of depression and bipolar disorder; the definition of the disorders; and psychological, social, and biological factors that have been shown to increase the risk of mood disorders in children and adolescents. Two major developments have taken place since the publication of the previous edition of this volume: new population-based studies and the publication of the DSM-5. The epidemiologic data reported in the previous edition were based on studies of adults and extrapolated rates in youth from retrospective reports of age of onset. Since then, a number of large-scale, population-based studies of children and adolescents have been conducted. This chapter presents new data directly derived from U.S. epidemiologic studies of youth either nationally or based on a selected community. The chapter also updates risk factors based on more current research and speculates on the implications of the DSM-5 criteria changes.

Mixed features of depression: why DSM-5 is wrong (and so was DSM-IV)

2013 ◽  
Vol 203 (1) ◽  
pp. 3-5 ◽  
Author(s):  
Athanasios Koukopoulos ◽  
Gabriele Sani ◽  
S. Nassir Ghaemi
Keyword(s):  
Diagnostic Criteria ◽  
Central Position ◽  
Mixed States ◽  
Dsm 5 ◽  
Mixed Features ◽  
Dsm Iv

SummaryThe DSM system has never acknowledged a central position for mixed states; thus, mixed depressions have been almost completely neglected for decades. Now, DSM-5 is proposing diagnostic criteria for depression with mixed features that will lead to more misdiagnosis and inadequate treatment of this syndrome. Different criteria, based on empirically stronger evidence than exists for the DSM-5 criteria, should be adopted.

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