Mania and depression. Mixed, not stirred

• Published in: Journal of affective disorders 2011-09, Vol.133 (1), p.105-113
• Main Authors: Pacchiarotti, Isabella, Mazzarini, Lorenzo, Kotzalidis, Giorgio D, Valentí, Marc, Nivoli, Alessandra M.A, Sani, Gabriele, Torrent, Carla, Murru, Andrea, Sanchez-Moreno, Jose, Patrizi, Barbara, Girardi, Paolo, Vieta, Eduard, Colom, Francesc
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Antidepressant drugs; Biological and medical sciences; Bipolar affective disorder; Bipolar disorder; Bipolar Disorder - classification; Bipolar Disorder - drug therapy; Bipolar Disorder - psychology; Bipolar disorders; Clinical course predictors; Comorbidity; Demographic aspects; Depression; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Male; Mania; Medical sciences; Mental Disorders; Middle Aged; Mixed episode; Mood disorders; Predominant polarity; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reproducibility of Results; Subtypes; Suicide; Suicide, Attempted - psychology; Suicide, Attempted - statistics & numerical data; Type I; Young Adult
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2011.03.037

Abstract Objective Current criteria for mixed bipolar episode do not allow an adequate understanding of a vast majority of bipolar patients with mixed (hypo) manic-depressive features, keeping the qualification of “mixed episodes” for bipolar type I only. This study was aimed to test the existence of a bipolar-mixed continuum by comparing the characteristics of three groups classified according to patterns of past and current manic or mixed episodes. Method 134 bipolar I inpatients were divided according to their pattern of excitatory “mixed-like” episodes in three groups: 1) lifetime history of purely manic episodes without mixed features (PMA); 2) lifetime history of both manic and mixed episodes (MIX) and 3) lifetime history exclusively of mixed, but not manic, episodes (PMIX). Differences in clinical and demographic characteristics were analyzed by using chi-square head-to-head for categorical data, one-way ANOVA for continuous variables and Tukey's post-hoc comparison. Logistic regression was used to control for data validity. Results PMIX had higher rates of depressive predominant polarity and less lifetime history of psychotic symptoms, and had received more antidepressants both lifetime and during 6 months prior to index episode. PMIX had more suicide attempts and Axis I comorbidity than PMA. Discussion PMIX is likely to have a higher risk for suicide and higher rates of comorbidities; current DSM-IV-TR criteria are not fit for correctly classifying these patients and this may affect treatment appropriateness. The concept of “mixicity” should be extended beyond bipolar I disorder to other bipolar disorder subtypes.