Mixed affective states

Symptoms of mixed affective states

Also known as a mixed episode, the symptoms of  both mania and depression are present, in addition to the following symptoms:

• agitation
• trouble sleeping
• significant change in appetite
• psychotic symptoms
• thoughts of suicide

Diagnosis of mixed affective episodes

To diagnose a mixed affective episode, patients should fulfill the symptom criteria for both major manic and depressive episodes, often exhibiting rapid alteration between, or a mixture of, these two states.

DSM-IV also adds that a diagnosis should include at least one of the following severe symptoms:

• psychotic features
• require hospitalisation to protect the patient or others
• impairs work, social, or personal functioning

In clinical practice many people have “mixed states” without meeting the full criteria for a mixed affective episode above. It is important to recognise these mixed states as the episodes often feel intensely unpleasant and the individual feels ‘out of control’.  These episodes are associated with increased suicide risk. They also tend to respond differently to treatment from ‘pure’ manic or depressive episodes.