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A pragmatic approach to the diagnosis and treatment of mixed features in adults with mood disorders

机译：一种务实的情绪障碍诊断和治疗成人混合特征的务实方法

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Mixed features specifier (MFS) is a new nosological entity defined and operationalized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), 5th Edition. The impetus to introduce the MFS and supplant mixed states was protean, including the lack of ecological validity, high rates of misdiagnosis, and guideline discordant treatment for mixed states. Mixed features specifier identifies a phenotype in psychiatry with greater illness burden, as evidenced by earlier age at onset, higher episode frequency and chronicity, psychiatric and medical comorbidity, suicidality, and suboptimal response to conventional antidepressants. Mixed features in psychiatry have historical, conceptual, and nosological relevance; MFS according to DSM-5, is inherently neo-Kraepelinian insofar as individuals with either Major Depressive Disorder (MDD) or Bipolar Disorder (BD) may be affected by MFS. Clinicians are encouraged to screen all patients presenting with a major depressive episode (or hypomanic episode) for MFS. Although "overlapping symptoms" were excluded from the diagnostic criteria (eg, agitation, anxiety, irritability, insomnia), clinicians are encouraged to probe for these nonspecific symptoms as a possible proxy of co-existing MFS. In addition to conventional antidepressants, second generation antipsychotics and/or conventional mood stabilizers (eg, lithium) may be considered as first-line therapies for individuals with a depressive episode as part of MDD or BD with mixed features.
机译：混合特征说明书（MFS）是在精神障碍（DSM），第5版的诊断和统计手册中定义和运行的新仪表实体。引进MFS和提金国的推动是诱使的，包括缺乏生态有效性，误诊率高，以及混合状态的指南不和谐治疗。混合特征说明符在精神病学中具有更大的疾病负担的表型，如令人疾病，更高的发作频率和慢性，精神病和医疗合并症，自由性和对常规抗抑郁药的次优响应所证明的。精神病学中的混合特征具有历史，概念和核对相关性;根据DSM-5的MFS，本质上是Neo-Kraepelinian，因为具有主要抑郁症（MDD）或双极性障碍（BD）的个体可能受MF的影响。鼓励临床医生筛选所有患者为MFS呈现出主要的抑郁发作（或疥疮）。虽然“重叠症状”被排除在诊断标准之外（例如，搅拌，焦虑，烦躁，失眠），临床医生被鼓励探讨这些非特异性症状，作为共同现有的MFS可能代理。除了常规抗抑郁药之外，第二代抗精神病药和/或常规情绪稳定剂（例如，锂）可以被认为是具有抑郁情节的个体的一线疗法，作为具有混合特征的MDD或BD的一部分。

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