Mixed states with predominant manic or depressive symptoms: Baseline characteristics and 24-month outcomes of the EMBLEM cohort

Predominant polarity in bipolar disorders: Further evidence for the role of affective temperaments

“…In contrast, in soft bipolar disorder patients, the number of previous hypomanic episodes was found to predict the occurrence of mixed depressive episodes (Azorin et al, 2012). These apparent discrepancies may be easily explained by the hypothesis that mixed states may occur when mood episodes arise from baseline temperaments of opposite polarity Azorin et al, 2013). Our data on affective temperaments confirm some of the previous findings by Henry et al (1999).…”

“…These discrepancies might be due to the exclusive or predominant recruitment of BP I patients in previous studies. In BP I patients, the frequency of mixed manic episodes has been linked to the number of previous depressive episodes ( Azorin et al, 2013), which may explain the association between polarity and mixicity. In contrast, in soft bipolar disorder patients, the number of previous hypomanic episodes was found to predict the occurrence of mixed depressive episodes (Azorin et al, 2012).…”

Characterizing the experience of auditory verbal hallucinations and accompanying delusions in individuals with a diagnosis of bipolar disorder: A systematic review

“…The prediction of levels of insight is clinically relevant given the acknowledged relationship between insight and responses to treatment . Azorin and colleagues, for example, found that medication compliance was significantly reduced in those with mixed mania by comparison to those with predominately mixed depressive episodes (30.4% complied no more than half the time by contrast with 10.4%, respectively) . Several reasons were cited for the difference in medication compliance between BD subtypes, including care management, and attitudes to mood states and to treatment regimes.…”

Bipolar Patients' Quality of Life in Mixed States: A Preliminary Qualitative Study

“…Mixed states are, in other words, clinical states in which symptoms of depression and mania combine and are characterized by the simultaneous presence of both depressive and manic symptoms [2]. Prevalence estimation for DSM-IV-TR and/or ICD-10 mixed episodes is approximately 20% of bipolar mood episodes but varies according to the diagnostic method [3,4,5]. …”

“…Mixed states represent a complex syndrome, and the clinical heterogeneity within mixed states confuses the clinical presentation of bipolar disorder (BD), with the risk of misdiagnoses and maltreatment [5]. Bipolar patients with mixed states have been shown to have more psychiatric comorbidity, poorer treatment response, increased relapse rate, decreased functional level, and higher risk of suicide [6,7,8,9,10,11].…”