In the context of mental illness, a mixed state (also known as dysphoric mania, agitated depression, or a mixed episode) is a condition during which symptoms of mania and depression occur simultaneously (e.g., agitation, anxiety, fatigue, guilt, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, pressured speech and rage). Typical examples include tearfulness during a manic episode or racing thoughts during a depressive episode. Mixed states can be the most dangerous period of mood disorders, during which substance abuse, panic disorder, suicide attempts, and other complications increase greatly. Mental illness (or emotional disability, cognitive dysfunction) is a broad generic label for a category of illnesses that may include affective or emotional instability, behavioral dysregulation, and/or cognitive dysfunction or impairment. ... Mania is a medical condition characterised by severely elevated mood. ... Clinical depression is a state of sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... Agitation may have the following special meanings Agitation, an emotional state Agitation, putting into motion (by shaking or stirring) Agitation, a term from the lexicon of Communists: political activities aimed at urging people to do something This is a disambiguation page — a navigational aid which lists other pages that... Anxiety is a complex combination of emotions that includes fear, apprehension and worry, and is often accompanied by physical sensations such as palpitations, nausea, chest pain and/or shortness of breath. ... Fatigue may refer to: Fatigue (physical) - tiredness in humans Fatigue (material) - failure by repeated stress in materials Fatigues (uniform) - military uniform (BDU or ACU) Chronic Fatigue Syndrome - a medical condition Battle fatigue - also known as Post-traumatic stress disorder Readers fatigue - a side-effect of parsing poorly formatted textual... Insomnia is characterized by an inability to sleep and/or to remain asleep for a reasonable period. ... A panic attack is a period of intense fear or discomfort, typically with an abrupt onset and usually lasting no more than thirty minutes. ... For other senses of this word, see paranoia (disambiguation). ... Substance abuse refers to the overindulgence in and dependence on a stimulant, depressant, chemical substance, herb (plant) or fungus leading to effects that are detrimental to the individuals physical health or mental health, or the welfare of others. ... A panic attack is a period of intense fear or discomfort, typically with an abrupt onset and usually lasting no more than 30 minutes. ... Suicide (from Latin sui caedere, to kill oneself) is the act of willfully ending ones own life. ...

Diagnostic criteria

As affirmed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a mixed state must meet the criteria for a major depressive episode and a manic episode nearly every day for at least one week. However, mixed episodes rarely conform to these qualifications; they may be described more practically as any combination of depressive and manic symptoms (Akiskal & Pinto, 1999; Goldman, 1999; Perugi et al., 1999). The Merck Manual of Diagnosis and Therapy (MMDT) splits the DSM-IV diagnosis into dysphoric mania and a depressive mixed state. The Diagnostic and Statistical Manual published by the American Psychiatric Association The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States. ... The Merck Manual of Diagnosis and Therapy (often referred to simply as The Merck Manual) is one of the worlds most widely used medical textbooks. ...

A dysphoric mania consists of a manic episode with depressive symptoms. Increased energy and some form of anger, from irritability to full blown rage, are the most common symptoms (MMDT). Symptoms may also include auditory hallucinations, confusion, insomnia, persecutory delusions, racing thoughts, restlessness, and suicidal ideation. Alcohol, drug abuse, and some antidepressant drugs may trigger dysphoric mania in susceptible individuals. An antidepressant is a medication designed to treat or alleviate the symptoms of clinical depression. ...

A depressive mixed state is a "major depressive episodes with superimposed hypomanic symptoms" (Benazzi, 2000). Mixed episodes in which major depression is the primary state, concurrent with atypical manic features were described in two studies (Benazzi & Akiskal, 2001; Perugi et al., 2001). A study by Goodwin and Ghaemi (2003) reported manic symptoms in two-thirds of patients with agitated depression, which they suggest calling "mixed-state agitated depression".

Treatment

Anticonvulsants (aka mood stabilizers) and antidepressants are the traditional medications used in the treatment of bipolar disorder and major depression, respectively. Antidepressants may induce mixed states and rapid cycling; coadministration with an anticonvulsant and/or lithium reduces (but does not eliminate) this risk. Among the anticonvulsants, only lamotrigine (Lamictal®) has strong antidepressant effects. Lamotrigine and lithium (not an anticonvulsant) are the only drugs FDA-approved for the maintenance treatment of bipolar disorder. These are the only "true" mood stabilizers in that they possess antidepressant as well as antimanic properties. Of the two, lamotrigine is the more effective treatment for bipolar depression and lithium is more effective for mania (Calabrese, Vieta & Shelton, 2003). The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. ... A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by rapid and unstable mood shifts. ... An antidepressant is a medication designed to treat or alleviate the symptoms of clinical depression. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... It is common to feel sad, discouraged , or down once in a while, and anyone in this state might say they are suffering from depression. ... Lamotrigine (marketed as Lamictal by GlaxoSmithKline) is an anticonvulsant drug used in the treatment of epilepsy and bipolar disorder. ... General Name, Symbol, Number lithium, Li, 3 Chemical series alkali metals Group, Period, Block 1, 2, s Appearance silvery white/gray Atomic mass 6. ...

Mixed states require medication (psychotherapy is best reserved for a more stable period). The anticonvulsant divalproex (Depakote®) is used frequently, particularly when psychotic features are present (MMDT). The atypical antipsychotics (such as clozapine (Clozaril®) and olanzapine (Zyprexa®)) are also effective, but only Abilify (aripiprazole) is US FDA-approved for bipolar mixed states. Electroconvulsive therapy may benefit the most severe cases. Look up Psychotherapy in Wiktionary, the free dictionary. ... Valproic acid or 2-Propylpentanoic acid is CH3CH2CH2CH(CH2CH2CH3)COOH . ... Psychosis is a psychiatric classification for a mental state in which the perception of reality is distorted. ... The atypical antipsychotics (also known as second generation antipsychotics) are a class of prescription medications used to treat psychiatric conditions. ... Clozapine (sold as Clozaril®, Leponex®, Fazaclo®) was the first of the atypical antipsychotics to be developed. ... Olanzapine (sold as Zyprexa®, Zydis®, or in combination with fluoxetine, as Symbyax®) was the second atypical antipsychotic to gain FDA approval and has become one of the most commonly used atypical antipsychotics. ... Categories: Stub | Atypical antipsychotics ... The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ... Electroconvulsive therapy (ECT) is a controversial psychiatric shock therapy involving the induction of a seizure in a patient by passing electricity through the brain. ...

References

• Akiskal, H.S. Pinto, O. (1999). The evolving bipolar spectrum. Prototypes I, II, III, and IV. Psychiatr Clin North Am. 22(3):517–34.
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.
• Benazzi, F. (2000). Depressive mixed states: unipolar and bipolar II [Abstract]. Eur Arch Psychiatry Clin Neurosci. 250(5):249–53.
• Benazzi, F. (2003). Bipolar II depressive mixed state: Finding a useful definition Compr Psychiatry. 44(1):21–7.
• Bipolar Disorders. (2005). The Merck Manual of Diagnosis and Therapy [Electronic version]. Accessed on April 01, 2005.
• Calabrese, J.R. Vieta, E. Shelton, M.D. (2003). Latest maintenance data on lamotrigine in bipolar disorder. Eur Neuropsychopharmacol. Suppl 2:S57–66.
• Goldman, E. (1999). Severe Anxiety, Agitation are Warning Signals of Suicide in Bipolar Patients. Clin Psychiatr News. pg 25.
• Going to extremes: Bipolar disorder. NIMH. Accessed on April 01, 2005.
• mixed states/atypical depression. neurotransmitter.net. Accessed on April 01, 2005.
• Perugi, G. Toni, C. Akiskal, H.S. (1999). Anxious-bipolar comorbidity. Diagnostic and treatment challenges. Psychiatr Clin North Am. 22(3):565–83.