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Mixed features in major depressive disorder: diagnoses and treatments

机译：主要抑郁症的混合特征：诊断和治疗

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摘要

For the first time in 20 years, the American Psychiatric Association (APA) updated the psychiatric diagnostic system for mood disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Perhaps one of the most notable changes in the DSM-5 was the recognition of the possibility of mixed symptoms in major depression and related disorders (MDD). While MDD and bipolar and related disorders are now represented by 2 distinct chapters, the addition of a mixed features specifier to MDD represents a structural bridge between bipolar and major depression disorders, and formally recognizes the possibility of a mix of hypomania and depressive symptoms in someone who has never experienced discrete episodes of hypomania or mania. This article reviews historical perspectives on "mixed states" and the recent literature, which proposes a range of approaches to understanding "mixity." We discuss which symptoms were considered for inclusion in the mixed features specifier and which symptoms were excluded. The assumption that mixed symptoms in MDD necessarily predict a future bipolar course in patients with MDD is reviewed. Treatment for patients in a MDD episode with mixed features is critically considered, as are suggestions for future study. Finally, the premise that mood disorders are necessarily a spectrum or a gradient of severity progressing in a linear manner is argued.
机译：在20年来，美国精神病协会（APA）在精神障碍诊断和统计手册中更新了精神病诊断系统，第五版（DSM-5）。也许DSM-5中最值得的变化之一是识别重大抑郁和相关疾病中混合症状的可能性（MDD）。虽然MDD和双极和相关障碍现在由2个不同的章节代表，但将混合特征说明符的添加到MDD代表双极和主要抑郁症之间的结构桥梁，并正式认识到某人羞辱和抑郁症状混合的可能性谁从未经历过丑陋或狂热的离散发作。本文审查了“混合国家”和最近的文学的历史观点，这提出了一系列理解“混合”的方法。我们讨论哪些症状被认为是包含在混合特征的说明书中，并排除症状。假设MDD中的混合症状必然预测MDD患者的未来双极课程。患有混合特征的MDD发作中的患者的治疗是批判性考虑的，这是未来研究的建议。最后，情绪障碍必然是一种以线性方式进展的频谱或严重程度的梯度的前提。

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