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July 3, 2005

Mixed Mania Results in Poor Diagnosis

Having mixed manic symptoms can often result in a poor diagnosis. Mixed mania is when one has a full manic episode concurrently with a full depressive episode for at least one week. Specifically, "the simultaneous occurrence of both manic and depressive features bears nosologic, therapeutic, and prognostic implications for the treatment and management of recurrent mood disorders".

"The distinction between mixed states and agitated depression has long been a source of controversy in the literature. It has been suggested that the psychomotor activation of mixed mania typically involves behaviors that are goal-directed,[8] while agitated depressions more often involve hyperarousal, inner tension, and fidgeting or pacing in the absence of goal-directedness.[9] Hostility and cognitive impairment have been observed more often in mixed/dysphoric mania than in agitated depression.[10] Still others argue for closer nosologic links between agitated depression and mixed mania than many clinicians often appreciate.[11,12] The consistency, or reliability, with which practitioners recognize mixed states appears more variable than is the case with pure manias.[13] However, phenomenologic studies indicate that the qualitative features of mania during pure vs mixed manic episodes may differ, with a greater prevalence of grandiosity and diminished need for sleep in the former rather than latter.[14] Moreover, mixed-state features have been shown to recur across subsequent episodes in a substantial subgroup of patients with bipolar disorder" (Goldberg & Ernst, 2005).

Having mixed manic episodes not only makes it more difficult for a physician to diagnose you, it also makes it harder for him to prescribe you something that will be effective for your episodes. It is easier to prescribe someone medication when their manic symptoms are separate from their depressive symptoms because there are drugs that are specifically made to individually fight against them. This article states that "Optimal clinical management involves the use of pharmacotherapies that target both manic and depressive features without inducing mood instability. Combination therapy approaches, typically involving divalproex with an atypical antipsychotic, alongside the elimination of antidepressants, currently represent the most evidence-based strategy for achieving and sustaining symptomatic remission" (Goldberg & Ernst, 2005). Finding what is right for the individual patient with mixed mania will often require different kinds of medicinal treatment.

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The source of this article was Medscape.


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