Bipolar Mixed Episodes

Article by Colleen Sullivan

Defined By the Authority
The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) recognizes only one form of mixed state in Bipolar Disorder, that of Depressive Mania. Many individuals who have suffered a mixed episode, and many psychiatrists would carry this farther. Although psychiatrists do not yet agree on the defining characteristics for this state, they have long recognized that the symptoms of mania and depression seem to co-exist in some patients.
 

A Timeless Theory
As many as one hundred years ago the physician Kraepelin suggested his theory of mixed mood states. He believed that they arose when mood, ideation, and psychomotor activity were incongruent. When all three were decreased, depression occurred; when all three were elevated the result was mania. If one of the domains was contradictory however, (for example, low mood with excitement and acceleration of activity), the diagnosis would be depressive mania. Kraepelin identified six different mixed states, in addition to the two pure states of mania and depression.

Psychiatrists today recognize that there are more variations than Depressive Mania within the spectrum of mixed states, although the characteristics have not been defined, nor are these states official. Clinical experience has identified several different states that could be termed mixed states. These include Depressive Mania, Irritable Mania, Anxious Mania, Excited depression and Agitated Depression and others may exist.

To read more about mixed states, and studies done on them see Dr. Hagop S. Akisal M.D.'s article at MEDSCAPE. A free membership is required.