Koukopoulos׳ diagnostic criteria for mixed depression: A validation study

Sani, Gabriele; Vöhringer, Paul A.; Napoletano, Flavia; Holtzman, Niki S.; Dalley, Shannon; Girardi, Paolo; Ghaemi, S. Nassir; Koukopoulos, Athanasios

doi:10.1016/j.jad.2014.03.054

Cited by 82 publications

(66 citation statements)

References 18 publications

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“…These findings suggest that we should be alert to the presence of depressive mixed state among patients with unipolar and bipolar depression even though it may be mild or subthreshold when considering appropriate treatments and risk management. Mixed psychopathology is more prevalent in patients with bipolar disorders than in patients with major depressive disorder [6,11] [15] proposed clinical definition of mixed depression (which is based on Koukopoulos's criteria for agitated depression [16]), i.e., a major depressive episode plus at least 3 out of the following 8 symptoms: 1) psychic agitation/inner tension, 2) racing or crowded thoughts, 3) irritability/unprovoked rage, 4) absence of retardation, 5) talkativeness, 6) dramatic description of suffering/frequent spells of weeping, 7) mood lability/marked reactivity and 8) early insomnia. Furthermore, in the Research-Based Diagnostic Criteria for mixed depression proposed by Perugi et al [7], mixed depression was defined as a major depressive episode plus at least 3 out of the following 14 hypomanic symptoms for one week or longer: 1) irritable mood, 2) emotional/mood lability, 3) distractibility, 4) psychomotor agitation, 5) impulsivity, 6) aggression (verbal or physical), 7) racing thoughts, 8) more talkative/pressure to keep talking, 9) risky behavior, 10) hyperactivity, 11) increased energy, 12) euphoria, 13) grandiosity and 14) hypersexuality.…”

Section: Symptomatology Of Depressive Mixed Statementioning

confidence: 99%

“…The cutoff point of the criteria for mixed depression has been always a central problem. Koukopoulos's criteria for mixed depression (≥ 3 out of 8 symptoms associated with mixed depression) showed fairly good specificity (86.3%) and sensitivity (76.4%) as well as a relatively high positive predictive value (86.0%) and negative predictive value (75.0%) when differentiating mixed depression from non-mixed depression [15]. However, such categorical criteria for mixed depression may essentially limit the sensitivity or specificity of the diagnosis and consequently result in false positives or false negatives.…”

Section: Diagnostic Considerations In Depressive Mixed Statementioning

confidence: 99%

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Diagnostic and Therapeutic Considerations in Depressive Mixed State

Kondo

Shinzato

Koda

2016

CNPT

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Although the definition of depressive mixed state, more commonly known as mixed depression, is still controversial, about one-third of major depressive episodes are held to contain mixed components. The most frequent manifestations of mixed depression are irritability, distractibility and psychomotor agitation, although these symptoms are not included in the mixed features during a major depressive episode according to the DSM-5 criteria, which is therefore unlikely to cover the full scope of mixed depression in real-world settings. Mixed depression often accompanies risky behavior including impulsive suicide attempts. The early detection and treatment of these unstable conditions is therefore necessary. Also, sufficiently sensitive and specific screening methods for depressive mixed state are needed to avoid both under-and over-diagnosis. Antidepressants should be avoided since these drugs often worsen irritability, agitation and impulsivity, and increase risky behavior. Instead, combination therapy with mood stabilizer(s) to prevent the relapse of the depressive mixed state and atypical antipsychotics for rapid stabilization in the acute phase should be considered. Because there is very little evidence for effective pharmacotherapy in mixed depression, the efficacy of various mood-stabilizing agents, either as monotherapy or in combination therapies, should be extensively examined in the future using quantitative assessments of the psychopathology of mixed depression in patients with confirmed diagnoses of mixed depression.

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Section: Symptomatology Of Depressive Mixed Statementioning

confidence: 99%

Section: Diagnostic Considerations In Depressive Mixed Statementioning

confidence: 99%

Diagnostic and Therapeutic Considerations in Depressive Mixed State

Kondo

Shinzato

Koda

2016

CNPT

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“…Also, the research‐based diagnostic criteria (RBDC; Angst et al, ; Angst et al, ; Perugi et al, ), as well as the empirically based criteria for mixed depression developed in Benazzi (, ) came to similar conclusions. Sani, Vöhringer, et al () and Sani, Napoletano, et al () and Koukopoulos et al () included hypomanic symptoms such as agitation, irritability, racing thoughts, and distractibility/lability among the core symptoms of mixed depression.…”

Section: Introductionmentioning

confidence: 99%

The prevalence and diagnostic classification of mixed features in patients with major depressive episodes: A multicenter study based on the DSM‐5

Shim

Lee

Kim

et al. 2019

Int J Methods Psych Res

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Objectives The purpose of this study was to evaluate the prevalence of mixed features using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) and to examine how patients with mixed states would be classified using the DSM‐5. Methods In total, 12 hospitals participated in this study, and data on the demographic characteristics and clinical diagnoses of patients treated between October 2013 and September 2016 were obtained. We reviewed the data for opposite‐polarity symptoms according to the DSM‐5 criteria and the research‐based diagnostic criteria. Results Of the 859 patients included in the final analysis, the prevalence of mixed features in patients with major depressive episodes based on the DSM‐5 remained low. Patients with major depressive disorder were more likely to be classified as experiencing anxious distress and/or a cluster‐B personality disorder in mixed state patients not diagnosed with DSM‐5 mixed features, whereas more mixed state patients with bipolar disorder were diagnosed with mixed features using the DSM‐5. Conclusions The prevalence of mixed features did not increase significantly when the DSM‐5 was used, and patients with mixed states were more likely to be classified as having anxious distress and/or a cluster‐B personality disorder in addition to mixed features.

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“…2) Hypomanic symptoms occurring during MDE are common, representing ¼ outpatients with MDE (33% in women). This finding has been recently replicated (Sani et al, 2014a(Sani et al, , 2014b.…”

Section: (2013)mentioning

confidence: 52%