Mixed-state bipolar I and II depression: Time to remission and clinical characteristics

Shim, In Hee; Woo, Young Sup; Jun, Tae‐Youn; Bahk, Won‐Myong

doi:10.1016/j.jad.2013.09.035

Cited by 24 publications

(20 citation statements)

References 26 publications

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“…[6][7][8] Mixed states are associated with elevated rates of relapse, suicide, comorbidity, and treatment resistance. [9][10][11][12] This review article invites the need for adequately powered clinical trials that seek to determine the efficacy, safety, and tolerability of psychotropic agents in mania, hypomania, or depression with mixed features. At the current time, only a limited number of studies has assessed the efficacy of treatments specifically for mood disorders with DSM-5-defined mixed features.…”

Section: Resultsmentioning

confidence: 99%

“…Reference lists from included articles were also manually searched for additional pertinent references. Of note, primary studies assessing treatments of DSM-IV-TR-defined mixed episodes were not systematically retrieved or reviewed in the current article, as this has been done by numerous other authors previously 3,9,[24][25][26][27] and the focus of the current article is on studies specifically evaluating the treatment of DSM-5-defined "mixed features" rather than DSM-IV-TR-defined "mixed episodes. "…”

Section: Methodsmentioning

confidence: 99%

“…[6][7][8] Moreover, mixed features are associated with more severe symptomatology, mood episode recurrence, higher rates of comorbidity, poorer clinical outcomes, and suicidality. [9][10][11][12] Given the relative recency of this new nosological entity (May 2013), only a limited number of studies has directly examined the efficacy of treatments for mood states with DSM-5-defined mixed features. [13][14][15][16][17][18][19][20][21][22] Further, to date, only the Florida Medicaid Guidelines have specifically addressed the treatment of mixed features.…”

Section: Introductionmentioning

confidence: 99%

“…23 At the current time, inadequate evidence exists to adequately inform evidencebased treatment guidelines for mixed features in BD, as randomized controlled trials (RCTs) assessing the efficacy of various treatments specifically for BD mood episodes with mixed features have yet to be conducted. Numerous RCTs have assessed the efficacy of treatments of DSM-IV-defined mixed episodes 3,9,[24][25][26][27] ; however, the translational application of these results to the treatment of DSM-5-defined mixed features is speculative, as the DSM-IV overlaps but is distinctly different.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of mixed features in bipolar disorder

Rosenblat

McIntyre

2016

CNS Spectr.

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Mood episodes with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-defined mixed features are highly prevalent in bipolar disorder (BD), affecting~40% of patients during the course of illness. Mixed states are associated with poorer clinical outcomes, greater treatment resistance, higher rates of comorbidity, more frequent mood episodes, and increased rates of suicide. The objectives of the current review are to identify, summarize, and synthesize studies assessing the efficacy of treatments specifically for BD I and II mood episodes (ie, including manic, hypomanic, and major depressive episodes) with DSM-5-defined mixed features. Two randomized controlled trials (RCTs) and 6 post-hoc analyses were identified, all of which assessed the efficacy of second-generation antipsychotics (SGAs) for the acute treatment of BD mood episodes with mixed features. Results from these studies provide preliminary support for SGAs as efficacious treatments for both mania with mixed features and bipolar depression with mixed features. However, there are inadequate data to definitively support or refute the clinical use of specific agents. Conventional mood stabilizing agents (eg, lithium and divalproex) have yet to have been adequately studied in DSM-5-defined mixed features. Further study is required to assess the efficacy, safety, and tolerability of treatments specifically for BD mood episodes with mixed features.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of mixed features in bipolar disorder

Rosenblat

McIntyre

2016

CNS Spectr.

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“…Therefore, it is assumed that some patients with mixed features are likely to be diagnosed (using other specifiers) with comorbid disorders other than mixed features. It is important to review the diagnostic classifications because they may have significant effects on illness course, treatment choice and response, and prognosis (Sani, Napoletano, et al, ; Seo et al, ; Serretti, ; Shim, Woo, Jun, & Bahk, ).…”

Section: Introductionmentioning

confidence: 99%

The prevalence and diagnostic classification of mixed features in patients with major depressive episodes: A multicenter study based on the DSM‐5

Shim

Lee

Kim

et al. 2019

Int J Methods Psych Res

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Objectives The purpose of this study was to evaluate the prevalence of mixed features using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) and to examine how patients with mixed states would be classified using the DSM‐5. Methods In total, 12 hospitals participated in this study, and data on the demographic characteristics and clinical diagnoses of patients treated between October 2013 and September 2016 were obtained. We reviewed the data for opposite‐polarity symptoms according to the DSM‐5 criteria and the research‐based diagnostic criteria. Results Of the 859 patients included in the final analysis, the prevalence of mixed features in patients with major depressive episodes based on the DSM‐5 remained low. Patients with major depressive disorder were more likely to be classified as experiencing anxious distress and/or a cluster‐B personality disorder in mixed state patients not diagnosed with DSM‐5 mixed features, whereas more mixed state patients with bipolar disorder were diagnosed with mixed features using the DSM‐5. Conclusions The prevalence of mixed features did not increase significantly when the DSM‐5 was used, and patients with mixed states were more likely to be classified as having anxious distress and/or a cluster‐B personality disorder in addition to mixed features.

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Neuropsychopharmacotherapy: Emergency Psychiatry

Messer¹,

Pajonk

2022

NeuroPsychopharmacotherapy

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Mixed-state bipolar I and II depression: Time to remission and clinical characteristics

Cited by 24 publications

References 26 publications

Treatment of mixed features in bipolar disorder

Treatment of mixed features in bipolar disorder

The prevalence and diagnostic classification of mixed features in patients with major depressive episodes: A multicenter study based on the DSM‐5

Neuropsychopharmacotherapy: Emergency Psychiatry

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