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Mixed features: evolution of the concept, past and current definitions, and future prospects

机译：混合特征：演变的概念，过去和当前定义，以及未来的前景

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Mixed states address the relationships between episodes and the course of an illness, presenting significant clinical challenges. Recurrent affective disorders were described thousands of years ago as dimensional disturbances of the basic elements of behavior, combining the characteristics of what we would now consider manic and depressive episodes. It was recognized from the beginning that combinations of depressive and manic features are associated with a severe illness course, including increased suicide risk. Early descriptions of affective disorders formulated them as systemic illnesses, a concept supported by more recent data. Descriptions of affective disorders and their course, including mixed states, became more systematic during the 19th century. Structured criteria achieved importance with evidence that, in addition to early onset, frequent recurrence, and comorbid problems, mixed states had worse treatment outcomes than other episodes. In contrast to 2000 years of literature on recurrent affective episodes and mixed states, the unipolar-bipolar disorder distinction was formalized in the mid-20th century. Mixed-state criteria, initially developed for bipolar disorder, ranged from fully combined depression and mania to the DSM-5 criteria, no longer limited to bipolar disorder, of a primary depressive or manic episode with at least three symptoms of the other episode type. The challenges involved in understanding and identifying mixed states center largely on what drives them, including (1) their formulation as either categorical or dimensional constructs, (2) the specificity of their relationships to depressive or manic episodes, and (3) specificity for bipolar versus major depressive disorder. Their existence challenges the distinction between bipolar and major depressive disorders. The challenges involved in identifying the underlying physiological mechanisms go to the heart of these questions.
机译：混合状态解决了剧集与病程之间的关系，呈现出显着的临床挑战。复发性情感障碍被描述为数千年前作为行为基本元素的尺寸干扰，结合了我们现在认为躁狂和抑郁发作的特点。从一开始就被认可，抑郁和躁狂特征的组合与严重疾病课程有关，包括增加自杀风险。情感障碍的早期描述将它们称为全身疾病，由最近数据支持的概念。情感障碍及其课程的描述包括混合状态，在19世纪变得更加系统。结构化标准实现了重要性，证据表明，除了早期发病，频繁复发和共聚问题外，混合状态的治疗结果比其他事件更差。与2000年的复发性情节发作和混合状态相比，单极双相情感障碍在20世纪中期正式化。混合状态标准，最初为双极性疾病开发，从完全组合的抑郁症和躁狂症到DSM-5标准，不再限于双极性障碍，原发性抑郁或躁狂发作的另外三种症状。理解和识别混合州中心的挑战在很大程度上涉及驱动它们的东西，包括（1）其作为分类或尺寸构建体的制剂，（2）与抑郁或躁狂事件的关系的特异性，以及（3）双极性的特异性与主要的抑郁症。他们的存在挑战双相和重大抑郁症之间的区别。识别潜在的生理机制所涉及的挑战旨在解决这些问题的核心。

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