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2 - Emerging concepts of mixed states: a longitudinal perspective

Published online by Cambridge University Press:  10 August 2009

By
Giulio Perugi  and
Hagop S. Akiskal
Edited by
Andreas Marneros  and
Frederick Goodwin
Giulio Perugi
Affiliation:
University of Pisa, Pisa, Italy
Hagop S. Akiskal
Affiliation:
University of California at San Diego and Veterans Administration Medical Center, La Jolla, CA, USA
Andreas Marneros
Affiliation:
Martin Luther-Universität Halle-Wittenburg, Germany
Frederick Goodwin
Affiliation:
George Washington University, Washington DC
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Summary

Mixed state (MS) refers to an affective condition in which depressive and manic symptoms are simultaneously present. It may manifest as a transitional condition, bridging one phase of the illness with another, or may exist as an independent clinical attack. In the latter case, along with mania and depression, MS represents a major phase of manic-depressive illness; however, it is often misdiagnosed because of its pleomorphic symptomatological presentation, as well as underdiagnosed because of inadequate diagnostic delimitation. There is no terminological uniformity in the literature, and there is a regrettable tendency to use terms such as “mixed state,” “mixed mania,” “depression during mania,” and “dysphoric mania” interchangeably. In this chapter, we critically review the empirical literature on different definitions of MS, focusing on their clinical validity. In doing so, we devote special attention to the evolution of MS in the overall course of manic-depressive illness.

Definition of bipolar mixed states

In the original description of MS given by Kraepelin (1899) and by his pupil Weygandt (1899), one or more of the main psychopathological features of mania (mood, cognition, psychomotor activity) were replaced by one or more of the main features of depression, and vice versa. This approach led Kraepelin to postulate six putative subtypes: (1) depression with flight of ideas; (2) excited depression; (3) depressive-anxious mania; (4) unproductive mania; (5) inhibited mania; and (6) manic stupor.

Keywords

bipolar depressionDSM-IVdysphoric maniamixed maniasyndromal depressionmixed statespsychotic experiences
Type
Chapter
Information
Bipolar Disorders
Mixed States, Rapid Cycling and Atypical Forms
 , pp. 45 - 60
Publisher: Cambridge University Press
Print publication year: 2005

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