Mixed Episode Criteria for Bipolar Disorder

Bipolar disorder is characterized by alternating periods of depression and mania or hypomania. A mixed episode is the simultaneous experience of depression and mania, which can be a contradictory and challenging condition.

Symptoms

• A study from the University of Siena School of Medicine found that approximately 40% of individuals with bipolar disorder will experience at least one mixed episode.
• Bipolar disorder with mixed features is defined as either a manic state with depressive symptoms or a depressive state with manic symptoms.
• Examples:
• Someone who is hyperactive (a symptom of mania) but also has feelings of guilt or remorse (a symptom of depression).
• Someone who is crying uncontrollably (a symptom of depression) but also has a racing mind and an urgent need to complete a task (symptoms of mania).
• Individuals experiencing mixed episodes often have more severe symptoms, more frequent recurrence of acute episodes, an increased risk of psychosis, and greater difficulty finding effective treatment.

Diagnosis

• If an individual is in a manic or hypomanic state with mixed features, they must meet the diagnostic criteria for a recent manic or hypomanic episode and also experience at least three symptoms of depression during the same timeframe.
• If an individual is in a depressed state with mixed features, they must meet the diagnostic criteria for a recent major depressive episode and also experience at least three symptoms of mania or hypomania during the same timeframe.

Treatment

• Treatment for a mixed episode of bipolar disorder is complex and may involve a combination of medications and therapies.
• Mood stabilizers and atypical antipsychotics are commonly prescribed.
• Depakote (sodium valproate) is an anticonvulsant that is often the first-line drug of choice for treating bipolar disorder with mixed features.
• Other mood-stabilizing anticonvulsants include Lamictal (lamotrigine) and Tegretol (carbamazepine).
• Atypical antipsychotics commonly prescribed include Abilify (aripiprazole), Risperdal (risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine).
• If medications fail to control the severity or frequency of acute episodes, electroconvulsive therapy (ECT) may be recommended.
• Therapy can also be helpful in managing mixed episodes and teaching coping mechanisms.

It is important for individuals with bipolar disorder to work closely with a healthcare team to develop an individualized treatment plan that addresses their specific needs and symptoms.