Measures of the DSM–5 mixed-features specifier of major depressive disorder

Abstract

During the past two decades, a number of studies have found that depressed patients frequently have manic symptoms intermixed with depressive symptoms. While the frequency of mixed syndromes are more common in bipolar than in unipolar depressives, mixed states are also common in patients with major depressive disorder. The admixture of symptoms may be evident when depressed patients present for treatment, or they may emerge during ongoing treatment. In some patients, treatment with antidepressant medication might precipitate the emergence of mixed states. It would therefore be useful to systematically inquire into the presence of manic/hypomanic symptoms in depressed patients. We can anticipate that increased attention will likely be given to mixed depression because of changes in the DSM-5. In the present article, I review instruments that have been utilized to assess the presence and severity of manic symptoms and therefore could be potentially used to identify the DSM-5 mixed-features specifier in depressed patients and to evaluate the course and outcome of treatment. In choosing which measure to use, clinicians and researchers should consider whether the measure assesses both depression and mania/hypomania, assesses all or only some of the DSM-5 criteria for the mixed-features specifier, or assesses manic/hypomanic symptoms that are not part of the DSM-5 definition. Feasibility, more so than reliability and validity, will likely determine whether these measures are incorporated into routine clinical practice.

Vortioxetine Induced Hypomania: A Case Presentation and Review of the Literature

“…It has been reported that temporary mixed or agitated depression with antidepressants may occur [ 18 ]. A mixed presentation of depressive and hypomanic symptoms may occur in the treatment of MDD patients [ 19 ]. In DSM-5, the "mixed" specifier was added to the MDD, which consists of major depression based on the B criterion of BD (at least three hypomanic features) [ 20 ].…”

Mixed Depression: A Mini-Review to Guide Clinical Practice and Future Research Developments

“…The Clinically Useful Depression Outcome Scale with questions for DSM-5 Mixed subtype (CUDOS-M, [ 62 ]). It is a self-assessment scale developed by Zimmerman et al (2014), which includes 13 items based on the DSM-5 specific criteria for MxD with satisfactory reliability and validity [ 63 ]. Each item of the scale is rated on a 5-point ordinal scale to indicate the frequency of symptoms during the past week (0 = not at all true [0 days]; 4 = almost always true [every day]), and the total score ranges from 0 to 52.…”

Depression Preceding Diagnosis of Bipolar Disorder

“…There are a large number of other criteria and scales for mixed symptoms which variably include (37)(38)(39) and exclude the three overlapping DSM symptoms (39). They also include other symptoms and validate exclusion of some of the more frank manic symptoms of DSM mixed symptom specifier such as euphoria, less commonly found in mixed depression-see the Koukopoulos Mixed Depression Rating Scale (40).…”