IntroductionMixed features refers to the presence of high and low symptoms occurring at the same time, or as part of a single episode, in people experiencing an episode of mania or depression. In most forms of bipolar disorder, moods alternate between elevated and depressed over time. A person with mixed features experiences symptoms of both mood “poles” – mania and depression – simultaneously or in rapid sequence.Aims and objectivesTo review the nosological status of bipolar mixed states and its treatment.MethodsOnline search/review of the literature has been carried out, using Medline/Pubmed, concerning “mixed states”, “affective disorder”, “bipolar disorder”.ResultsThe presence of depressive symptomatology during acute mania has been termed mixed mania, dysphoric mania, depressive mania or mixed bipolar disorder. Highly prevalent, mixed mania occurs in at least 30% of bipolar patients. Correct diagnosis is a major challenge. The presence of mixed features is associated with a worse clinical course and higher rates of comorbidities. There is ongoing debate about the role of antidepressants in the evolution of such states.ConclusionsClinical vigilance and careful evaluation are required to ensure mixed states are not missed in the clinical context. Atypical antipsychotics are emerging as the medications of choice in the pharmacological management of mixed states.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionParkinson's disease is the most common neurodegenerative movement disorder in the elderly population. The disease is clinically characterized by major motor symptoms that include bradykinesia, rigidity, tremor and postural instability. In addition to the motor symptoms, Parkinson‘s disease is characterized by emotional and cognitive deficits, which reduce quality of life independently from motor manifestations.Objectives/AimsTo discuss the clinical manifestations of depression in Parkinson's disease according to the most recent scientific literature.MethodsOnline search/review of the literature has been carried out, using Medline/Pubmed, concerning, “Parkinson's disease” and “depression”.ResultsDepression is the most frequent psychiatric disorder in Parkinson's disease. In up to 30% of the cases, the depressive symptoms precede the development of motor symptoms. Independently of the age of appearance, duration and severity of the motor symptoms, depression is generally an integral part of the disease. Depression in Parkinson's disease is generally mild or moderate, with premature loss of self-esteem and volition. Although the high rates of suicidal ideation, suicide is rare. There is also a high prevalence of panic attacks and anxiety.ConclusionsIt is difficult to correctly identify depression in Parkinson's disease as some symptoms assigned to Parkinson's disease itself can in fact be the clinical manifestation of a depressive disorder. On the other hand, depressive symptoms may not be recognized as such, but considered manifestations of Parkinson's disease.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPostpartum psychosis (or puerperal psychosis) is a term that covers a group of mental illnesses with the sudden onset of psychotic symptoms following childbirth. A typical example occurs when after childbirth, a woman becomes irritable, has extreme mood swings and hallucinations with the possibility of needing psychiatric hospitalization. Often, out of fear of stigma or misunderstanding, women hide their condition.Aims and objectivesTo review the evidence regarding prophylactic treatment and acute management of postpartum psychosis and affective disorders in the puerperium.MethodsOnline search/review of the literature has been carried out, using Medline/Pubmed, concerning “postpartum psychosis”, “postpartum”, “mental disorders”, “mania” and “depression”.ResultsPostpartum psychosis is a rare and severe psychiatric condition requiring rapid restoration of health in view of significant risks to both mother and the infant. The known risk factors and negative consequences of postpartum psychosis point to the importance of preventive and acute treatment measures. The majority of patients who develop psychosis immediately following childbirth suffer from bipolar disorder.ConclusionsUnderstanding the relationship between postpartum psychosis and affective disorders has implications for perinatal and long-term treatment. The rapid and accurate diagnosis of postpartum psychosis is essential to expedite appropriate treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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