Updated May 20, 2010
The Mixed Episode will be replaced with the with Mixed Features Specifier.
Depressive, Manic, or Hypomanic episode, with or without mixed features - Literature Review (Swann; draft submitted 4/28/09); Review of previous analyses by Swann; analyses of the Stanley Foundation NFS database (w/Gerhard Helleman).
Other analyses pending – ISBD and STEP-BD
For those individuals who do meet full episodic criteria for both mania and depression, the suggestion was that mania trumps depressive episodes in severity, and thus, those individuals would fall under the category of Manic Episode with mixed features JUSTIFICATION pending.
References
12. Suppes et al. Mixed hypomania in 908 patients with bipolar disorder evaluated prospectively in the Stanley Foundation Bipolar Treatment Network: a sex-specific phenomenon. Arch Gen Psychiatry 2005; 62: 1089-1096.
13. Swann et al. Archives of General Psychiatry 1997; 54: 37-42.
14. Swann et al., Manic symptoms and impulsivity during bipolar depressive episodes. Bipolar Disorders 2007; 9: 206–212
15. Agosti & Stewart. Hypomania with and without Dysphoria: Comparison of comorbidity and clinical characteristics of respondents from a national community sample. J Affect Disord 2008; 108: 177–182.
Sato, T., Bottlender, R., Schroter, A.,Moller, H.J.: Frequency of manic symptoms during depressive episode and unipolar ‘depressive mixed state as bipolar spectrum. Acta Psychiatry Scand 107(4):268-274,2003.
This is not a codeable disorder; therefore, there are no severity criteria proposed.
Mixed Episode
A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Mixed-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.