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Mixed features in bipolar disorder

机译：双相障碍中的混合特征

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Mixed affective states, defined as the coexistence of depressive and manic symptoms, are complex presentations of manic-depressive illness that represent a challenge for clinicians at the levels of diagnosis, classification, and pharmacological treatment. The evidence shows that patients with bipolar disorder who have manic/hypomanic or depressive episodes with mixed features tend to have a more severe form of bipolar disorder along with a worse course of illness and higher rates of comorbid conditions than those with non-mixed presentations. In the updated Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), the definition of "mixed episode" has been removed, and subthreshold nonoverlapping symptoms of the opposite pole are captured using a "with mixed features" specifier applied to manic, hypomanic, and major depressive episodes. However, the list of symptoms proposed in the DSM-5 specifier has been widely criticized, because it includes typical manic symptoms (such as elevated mood and grandiosity) that are rare among patients with mixed depression, while excluding symptoms (such as irritability, psychomotor agitation, and distractibility) that are frequently reported in these patients. With the new classification, mixed depressive episodes are three times more common in bipolar II compared with unipolar depression, which partly contributes to the increased risk of suicide observed in bipolar depression compared to unipolar depression. Therefore, a specific diagnostic category would imply an increased diagnostic sensitivity, would help to foster early identification of symptoms and ensure specific treatment, as well as play a role in suicide prevention in this population.
机译：与抑郁和躁狂症状的共存混合的情感态度是躁狂抑郁症的复杂介绍，这对诊断，分类和药理治疗水平的临床医生表示挑战。证据表明，具有混合特征的躁狂/低级或抑郁发作的双相情感障碍的患者往往具有更严重的双相障碍形式，以及较差的疾病过程以及比具有非混合介绍的患者的合并条件较高。在更新的诊断和统计手册（第5个ED .; DSM-5）中，已被移除的定义，并使用“混合功能”说明符捕获相反杆的亚阈值的亚阈值。狂躁，傻瓜和主要抑郁发作。但是，DSM-5说明符中提出的症状列表已被广泛批评，因为它包括典型的躁狂症（如升高的情绪和壮大），这些症状在混合抑郁症的患者中罕见，同时排除症状（例如烦躁，精神病患者在这些患者中经常报道的搅拌和分散性。随着新分类，与单极抑制相比，混合抑郁症与双极抑郁相比，双极抑制作用三倍常见，与单极抑郁相比，双极抑制与双极抑郁症观察到的自杀风险增加。因此，特定的诊断类将暗示增加诊断敏感性，有助于促进早期鉴定症状并确保具体的治疗，并在本人自杀中发挥作用。

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