When is the DSM-5 mixed features specifier used in the diagnosis of bipolar disorder?

Updated: May 30, 2019
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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The mixed symptomatology is quite common in patients presenting with bipolar symptomatology. This often causes a diagnostic dilemma [68] and has prompted a revision to the definition of bipolar disorder in DSM-5. With the aim of capturing mixed symptoms more effectively, the “mixed episode” diagnosis has been eliminated in favor of a “mixed features specifier” that could be added to any mood bipolar disorder diagnosis. [69] Other specifiers include anxious distress, rapid cycling, mood-congruent psychotic features, catatonia, peripartum onset and seasonal pattern.

Of interest, when investigating bipolar mixed states, Swann and colleagues concluded that although controversy exists regarding the definitions and properties of mixed states, the concept of mixed states and their characteristics over a range of clinical definitions and diagnostic methods has remained consistent. [70] Moreover, “distinct characteristics related to the course of illness emerge at relatively modest opposite polarity symptom levels in depressive or manic episodes.” [70]

In addition to the well-known differences between manic and hypomanic episodes, other key differences exist between BPI and BPII that may be used to help distinguish between the 2 types of conditions. Data from 1429 bipolar patients included in the National Epidemiological Survey on Alcohol and Related Conditions showed significant differences between BPI and BPII patients in unemployment, a history of a suicide attempt, depressive symptoms (eg, weight gain, feelings of worthlessness), and the presence of specific phobias. [71]

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