Young2020. Young AH, Eberhard J. Evaluating depressive symptoms in mania: a naturalistic study of patients with bipolar disorder. Neuropsychiatr Dis Treat. 2015;11:1137-43.
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Centers in Australia, Brazil, Canada, Germany, Italy, Spain, Turkey, and the UK. |
To evaluate BD-I manic patients who met the DSM-5 criteria for BD-I “with mixed features.” |
The study surveyed psychiatrists and their BD-I manic patients. Data were stratified and characteristics were compared between PM and mMX subgroups. |
1,035 BD-I: 348 mMX, 687 PM |
Mean age (y): 40; Female gender (%): 52; Employed (%): 44 |
DSM-5 |
Number of patients with at least one suicide attempt |
mMX (38%) > PM (9%) |
Reinares2121. Reinares M, Bonnín Cdel M, Hidalgo-Mazzei D, Undurraga J, Mur M, Nieto E, et al. Making sense of DSM-5 mania with depressive features. Aust N Z J Psychiatry. 2015;49:540-9.
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Catalonia, Spain. |
To compare manic patients with and without mixed features to validate the relevance of the DSM-5 mixed specifier. |
Bipolar patients presenting a manic episode were evaluated and systematically assessed for a 6-month period. |
169 BD-I: 46 mMX, 123 PM |
Mean age (y): mMX = 41.85, PM = 44.35; Female gender (%): mMX = 43.3, MP = 45.7; Married (%): PM = 35.8, mMX = 141.3; Employed (%): PM = 29, mMX = 19 |
DSM-5 |
Number of patients with suicidal ideation |
mMX (26.1%) > PM (12.3%) |
Shim2222. Shim IH, Woo YS, Jun TY, Bahk WM. A reevaluation of the possibility and characteristics in bipolar mania with mixed features: a retrospective chart review. Psychiatry Res. 2014;215:335-40.
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Seoul, South Korea |
To reevaluate the feasibility of diagnosing a bipolar mixed mania and to elucidate the clinical characteristics, treatment response, and course of the illness. |
BD-I manic inpatients were divided according to Cincinnati criteria. Charts were reviewed for demographic and clinical characteristics. |
171 BD-I: 67 PM, 79 PMX, 25 DMX |
Mean age (y): PM = 41.8, PMX = 35.2, DMX = 33.2; Female gender (%): PM = 40.3, PMX = 70.9, DMX = 68; Married (%): PM = 59.7, PMX = 46.8, DMX = 52 |
Cincinnati criteria |
Number of patients with suicidal ideation or with at least one suicide attempt |
DMX (28%) > PM (0%); PMX (5.1%) = PM (0%); DMX (28%) > PMX (5.1%) |
Cassidy2323. Cassidy F, Ahearn E, Carroll BJ. Concordance of self-rated and observer-rated dysphoric symptoms in mania. J Affect Disord. 2009;114:294-8.
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USA |
To examine whether patients’ depression self-ratings agree with observer ratings and whether patients rate their depressive symptoms differently during manic and mixed episodes. |
Patients’ depression self-ratings were compared with observer ratings, as were differences between the manic and mixed subtypes. |
94 BD-I: 65 PM, 29 Mmx |
Mean age (y): 40.9; Female gender (%): 39.4; Ethnic group (%): Whites: 57.4, Blacks: 42.6 |
ROC-derived |
Mean scores on the suicide items of HAM-D and CDS scales |
HAM-D: mMX (0.759) > PM (0); CDS: mMX (0.759) > PM (0.108) |
Schwartzmann2424. Schwartzmann AM, Amaral JA, Issler C, Caetano SC, Tamada RS, Almeida KM, et al. A clinical study comparing manic and mixed episodes in patients with bipolar disorder. Rev Bras Psiquiatr. 2007;29:130-3.
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São Paulo, Brazil |
To compare severity between mixed and pure manic episodes. |
BD-I mixed and pure manic patients were compared for sociodemographic data and clinical characteristics. |
49 BD-I: 29 MX, 20 PM |
Mean age (y): PM = 42, MX = 34.8; Female gender (%): MX = 72.4, PM = 80 |
DSM-IV |
Number of patients with at least one suicide attempt |
MX (6.9%) = PM (0%) |
Cassidy55. Cassidy F, Carroll BJ. Frequencies of signs and symptoms in mixed and pure episodes of mania: implications for the study of manic episodes. Prog Neuropsychopharmacol Biol Psychiatry. 2001;25:659-65.
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Butner, North Carolina, USA |
To compare frequencies of the 20 signs and symptoms of SMS between pure and mixed mania. Subtypes were determined by the ROC-derived criteria. |
BD inpatients were diagnosed as manic or mixed using the ROC-derived criteria. Frequencies of each sign or symptom of SMS were compared. |
363 BD: 280 PM, 83 MX |
Mean age (y): 42.1; Female gender (%): 52; Ethnic group (%): Whites: 58.7, Blacks: 40.8, American Indian: 0.3, Asian American: 0.3. |
ROC-derived |
Number of patients with suicidal ideation according to the SMS suicide item |
High threshold (≥ 2 points): MX (31.3%) > PM (0.7%); Low threshold (1 point): MX (49.4%) > PM (4.6%) |
Cassidy2525. Cassidy F, Murry E, Forest K, Carroll BJ. Signs and symptoms of mania in pure and mixed episodes. J Affect Disord. 1998;50:187-201.
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Butner, North Carolina, USA |
To compare frequencies of the 20 signs and symptoms of SMS between pure and mixed mania. Subtypes were determined with the DSM-III-R. |
BD inpatients were diagnosed as manic or mixed using the DSM-III-R criteria. Frequencies of each sign or symptom of SMS were compared. |
316 BD-I: 273 PM, 43 MX |
Mean age (y): 42.2; Female gender (%): 53.2; Ethnic group (%): Whites: 57, Blacks: 42.4, Oriental: 0.3, American Indian: 0.3 |
DSM-III-R |
Number of patients with suicidal ideation according to the SMS suicide item |
High threshold (≥ 2 points): MX (39.5%) > PM (1.8%); Low threshold (1 point): MX (58.8%) > PM (8.8%) |
Goldberg2626. Goldberg JF, Garno JL, Leon AC, Kocsis JH, Portera L. Association of recurrent suicidal ideation with nonremission from acute mixed mania. Am J Psychiatry. 1998;155:1753-5.
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New York, USA |
To examine suicidality in relation to acute symptom remission in inpatients with mixed and pure BD. |
Using chart review, the authors assessed suicidality, other psychopathology, treatment, and remission of BD-I inpatients. |
184 BD-I: 77 PM, 107 MX |
Mean age (y): 40.4; Female gender (%): 53.8; Ethnic group (%): Whites: 72.3 |
Cincinnati criteria |
Number of patients with suicidal ideation or with at least one suicide attempt |
MX (57.9%) > PM (1.3%) |
Dilsaver2727. Dilsaver SC, Chen YW, Swann AC, Shoaib AM, Tsai-Dilsaver Y, Krajewski KJ. Suicidality, panic disorder and psychosis in bipolar depression, depressive-mania and pure-mania. Psychiatry Res. 1997;73:47-56.
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Harris County, Texas, USA |
To assess links between suicidality, panic disorder, psychosis, bipolar depression, depressive-mania, and pure-mania. |
BD inpatients in different illness phases were evaluated. Suicidality, intra-episode panic disorder, and psychotic features were ascertained. |
129 BD: 53 MDE, 32 MX, 44 PM |
Mean age (y): MDE = 34, PM = 33.4,, MX = 32.1; Female gender (%): MDE = 64.1, PM = 54.5, MX = 56.3 |
RDC mania + RDC major depression |
Number of patients with a score ≥ 3 in the SADS suicide item |
MX (56.3%) > PM (2.3%) |
Perugi77. Perugi G, Akiskal HS, Micheli C, Musetti L, Paiano A, Quilici C, et al. Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases. J Affect Disord. 1997;43:169-80.
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Pisa, Italy |
To validate and clinically characterize mixed bipolar states derived from the concepts of Kraepelin and the Vienna School, using the Pisa criteria. |
MX patients diagnosed according to Pisa criteria were compared with DSM-III-R PM patients. |
261 BD-I: 118 PM, 143 MX |
Mean age (y): MX = 37.3, PM = 39.3; Female gender (%): MX = 60.1, PM = 56.8 |
Pisa criteria |
Number of patients with at least one suicide attempt |
MX (14.7%) > PM (0%) |
Strakowski2828. Strakowski SM, McElroy SL, Keck PE Jr, West SA. Suicidality among patients with mixed and manic bipolar disorder. Am J Psychiatry. 1996;153:674-6.
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Cincinnati, Ohio, USA |
To determine whether suicidality in mania is associated with increasing depression in general or with the presence of a mixed state per se. |
Categorical and dimensional assessments of BD-I inpatients were performed. Mixed and manic bipolar subtypes were compared. |
91 BD-I: 57 PM, 34 MX |
Mean age (y): 26; Female gender (%): 43; Ethnic group (%): Caucasian: 55, African-American: 40, Not specified: 5 |
DSM-III-R |
Number of patients with a score > 1 in the HAM-D suicide item |
MX (26%) > PM (7%) |
Dilsaver2929. Dilsaver SC, Chen YW, Swann AC, Shoaib AM, Krajewski KJ. Suicidality in patients with pure and depressive mania. Am J Psychiatry. 1994;151:1312-5.
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Houston, Texas, USA |
To determine the rate and severity of suicidality among patients with pure and depressive mania. |
Severity of current suicidality was compared between patients with pure and depressive mania. |
93 BD-I: 49 PM, 44 MX |
Mean age (y): PM = 35.2, MX = 32.8; Female gender (%): 61.3; Ethnic group (%): Caucasians: 60.2, African-Americans: 29, Hispanics: 7.5, Not specified: 3.2 |
RDC mania + RDC major depression |
Number of patients with a score ≥ 3 in the SADS suicide item |
MX (54.5%) > PM (2%) |