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J Affect Disord. 2016 Mar 1;192:104-8. doi: 10.1016/j.jad.2015.12.009. Epub 2015 Dec 18.

Are manic symptoms that 'dip' into depression the essence of mixed features?

Author information

1
CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, NSW, Australia; Mood Disorders Unit, Northside Clinic, Ramsay Mental Health, Greenwich, NSW, Australia. Electronic address: Gin.malhi@sydney.edu.au.
2
CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, NSW, Australia.
3
Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universitaet Muenchen, Germany.
4
Mood Disorders Unit, Northside Clinic, Ramsay Mental Health, Greenwich, NSW, Australia.

Abstract

BACKGROUND:

Three symptoms of (hypo)mania that clinically represent mood disorders mixed states have been omitted from the DSM-5 mixed features specifier because 'they fail to discriminate between manic and depressive syndromes'. Therefore, the present study examined the role of distractibility, irritability and psychomotor agitation (DIP) in characterising mixed depressive states.

METHODS:

Fifty in-patients at a specialist mood disorders unit underwent a detailed longitudinal clinical evaluation (3-6 weeks) and were assessed on a range of standardized measures to characterise their illness according to depression subtype, duration of illness and clinical features-including specifically depressive and manic symptoms and the context in which these occur.

RESULTS:

49 patients met criteria for major depressive episode, and of these, 34 experienced at least one dip symptom. Patients who endorsed distractibility were more likely to be diagnosed with Bipolar Disorder than Major Depressive Disorder; patients who endorsed irritable mood were more likely to have non-melancholic depression (admixture of depressive and anxiety symptoms), and patients who reported psychomotor agitation experienced a significantly greater number of distinct periods of (hypo)manic symptoms compared with those who did not.

LIMITATIONS:

The present study used a modest sample size and did not control for medication or comorbid illness. Although this is inevitable when examining real-world patients in a naturalistic setting, future research needs to allow for comorbidity and its impact, specifically anxiety.

CONCLUSIONS:

The present findings suggest that all 3 symptoms that have been excluded from DSM-5 may be cardinal features of mixed states, as they 'dip' into depressive symptoms to create a mixed state.

KEYWORDS:

Bipolar disorder; DSM-5; Distractibility; Irritability; Mixed states; Psychomotor agitation

PMID:
26717522
DOI:
10.1016/j.jad.2015.12.009
[Indexed for MEDLINE]

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