Mixed forms in bipolar disorder and relation to gender

Résumé

Mixed states describe the simultaneous presence of manic and depressive symptoms in the same patient. This phenomenon is more prevalent in women. Activation, thinking, and mood are combined in a strange form, and it is possible that some of these dimensions are increased from the euthymic period, whereas others are decreased. The presentation of irritable mood is quite common, along with rapid thinking, suicidal ideas, anxiety, helplessness, and sexual disinhibition. Sometimes there are variations in the clinical presentation on the same day. There are some depressive symptoms present in the mixed states that are more relevant for diagnosis: depressed mood, guilt, suicidal ideation, anhedonia, and fatigue. Irritable mood and psychotic symptoms are also frequently present in mixed states. One aspect that is relevant for the prognosis of mixed states is the earlier age at onset. The younger age at onset, and the delay in the diagnosis, explain some, but not all, of the differences in prognosis of this severe disease. These patients are also at a higher risk of drug and alcohol abuse. Currently, the DSM-5 has partially included this aspect and has considered the diagnosis of mixed symptoms as a specifier of mania, hypomania, bipolar depression, andunipolar depression. The special follow-up of those patients with unipolar major depression and three manic symptoms is currently diagnosed as major depression with mixed symptoms. A careful follow-up should be made in those patients to consider a bipolar disorder in the future.