Bipolar Disorder: Open Access
Open Access

Criteria of Mixed Episode in Bipolar Disorder

Roberto Maniglio^{* *}Correspondence: Associate Professor. Roberto Maniglio, Department of Clinical Psychology, Mercatorum University, Rome, Italy, Email:

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Introduction

Bipolar disorder is commonly thought of as a condition characterized by alternating episodes of depression and mania. While some people with the condition do experience a distinct pendulum swing in moods with clear peaks and lows, the clinical image is more often than not so apparent. Depressive episodes can be the predominant characteristic of the disorder in many cases. At other times, a person can suffer from hypomania, a milder type of mania in which the elevated mood is less evident, particularly to casual observers. Perhaps more perplexing is a condition known as bipolar disorder with mixed characteristics, in which a person experiences depression and mania at the same time. Although having a manic and depressed state at the same time can seem contradictory, it is more normal than you would expect.

Diagnosis with Mania

If you're in a manic or hypomanic condition with mixed characteristics, you've met all of the diagnostic requirements for a recent manic or hypomanic episode, but you've also had at least three signs of depression for the majority of that time:

• A constant sense of depression or emptiness
• A lack of interest or enjoyment in things you typically enjoy
• Talk or respond more slowly than usual
• Persistent exhaustion and loss of energy
• Feelings of worthlessness or inappropriate remorse
• Frequent thoughts of death or suicide

The doctor must rule out any causes of depressive symptoms, such as alcohol dependence or the use of prescription or recreational medications like opioids or benzodiazepines.

This is particularly notable considering the fact that more than half of people diagnosed with bipolar disorder misuse drugs and/or alcohol. Substance misuse is usually linked to a worsening of the condition and a lack of control over bipolar symptoms.

Diagnosis with Depression

You'll meet the full medical requirements for a recent major depressive episode if you're depressed with mixed characteristics, but you'll also have experienced at least three signs of mania or hypomania for the majority of the same time period:

• A mood that is overly euphoric and expansive.
• Constant talking or feeling forced to keep talking
• Racing thoughts or flight of ideas
• Increased motivation with an emphasis on goal-oriented tasks
• Unwarranted risk-taking (financial, physical, sexual, etc.)
• A decreased need for sleep

To make the diagnosis, the doctor must rule out other possibilities, such as a psychiatric condition or prescription or recreational stimulants like crystal methamphetamine, cocaine, or Ritalin

Treatment

A mixed episode of bipolar disorder may be difficult to treat, and it may require a combination of mood stabilisers and atypical antipsychotics. 3 Antidepressants should almost always be avoided since they can exacerbate mood problems.

Depakote (sodium valproate) is an anticonvulsant medication that also works as a mood stabiliser. In the treatment of bipolar disorder with mixed characteristics, it is often the first-line medication of choice. Lamictal (lamotrigine) and Tegretol are two other mood-stabilizing anticonvulsants (carbamazepine).

Abilify (aripiprazole), Risperdal (risperidone), Seroquel (quetiapine), and Zyprexa are some of the most widely prescribed atypical antipsychotics (olanzapine). In some situations, these agents will be used alone, and in others, they will be used in conjunction with another form of mood stabiliser.

References

1. Purse M. Mixed Episode Criteria for Bipolar Disorder. Verywellmind. 2020.
2. Truschel J. Bipolar Definition and DSM-5 Diagnostic Criteria. Psycom. 2021.