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

Abstract

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.

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations

“…13 A detailed and longitudinal appraisal is required to clarify the diagnosis, which may be further confounded by personality, substance use, and/or anxiety comorbidity. [35][36][37][38] Clinicians may use the Montgomery Asberg Depression Rating Scale (MADRS) 39 and the Young Mania Rating Scale (YMRS) 40 to evaluate severity of depressive and manic symptoms, respectively, in patients with mixed presentations. The Clinically Useful Depression…”

Diagnostic Issues of Depressive Disorders from Kraepelinian Dualism to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

“…[22][23][24] Moreover, recent studies have reported that major depressive episode (MDE) mixed features are characterized by a low prevalence, the predominance of anxious distress, the prevalence of cluster B personality disorders, and pharmacological treatment with antipsychotics. [25][26][27] Thus, as shown in Figure 1, the specifier "with mixed features" may indicate quantitative but not qualitative overlapping symptoms from one pole to the opposite pole in the dichotomization of mood disorders into bipolar and depressive disorders.…”

<p>Ketamine in Bipolar Disorder: A Review</p>

“…Therefore, the authors suggest that this treatment should be considered in depression with mixed features, which is particularly common in bipolar disorders (2.2 in MDD vs 14.3% in BD) and related to high suicidality. 26,27 Rapid Antisuicidal Effect of Ketamine Suicidality accounts for 15-20% of deaths in BD patients. [28][29][30] Risk of suicidal act in BD patients with mixed or psychotic symptoms is one of the highest of all psychiatric disorders.…”

“…Therefore, the authors suggest that this treatment should be considered in depression with mixed features, which is particularly common in bipolar disorders (2.2 in MDD vs 14.3% in BD) and related to high suicidality. 26 , 27 …”