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Mixed state discrimination: a DSM problem that won׳t go away?
Gin S Malhi1, Lisa Lampe1, Carissa M Coulston1
1CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, NSW, Australia.
Journal of Affective Disorders
|March 25, 2014
Summary
Psychomotor agitation and distractibility are key symptoms of mixed states in mood disorders. These features were more prevalent in patients with mixed depression and bipolar spectrum disorder compared to unipolar depression and bipolar I disorder.
Area of Science:
- Psychiatry
- Mood Disorders
- Clinical Psychology
Background:
- The Diagnostic and Statistical Manual of Mental Disorders (DSM) specifier 'mixed features' may lack specificity by overlooking psychomotor agitation and distractibility.
- These symptoms are crucial for a comprehensive understanding of mood disorder presentations.
Purpose of the Study:
- To investigate the prevalence of psychomotor agitation and distractibility across the mood disorder spectrum.
- To determine if these symptoms differentiate between various mood disorder classifications.
Main Methods:
- Two hundred patients were clinically evaluated and categorized into depression, bipolar spectrum disorder (BDspectrum), and bipolar disorder groups.
- The depression group was further divided into unipolar depression (UP) and mixed depression (UPmix) based on MDQ scores.
- Psychomotor agitation and distractibility were assessed using clinical evaluation and questionnaires.
Main Results:
- Increased distraction, racing thoughts, and irritability were common manic symptoms in the unipolar depression group.
- Mixed depression (UPmix) and bipolar spectrum disorder (BDspectrum) groups exhibited significantly higher levels of psychomotor agitation and distractibility.
- These findings suggest a distinct pattern of symptoms in mixed states.
Conclusions:
- Distractibility and psychomotor agitation may be core features of mixed mood states.
- These symptoms are more common in mixed depression and bipolar spectrum disorder than in unipolar depression or bipolar I disorder.
- Further research is needed to validate these findings with standardized measures and explore pure unipolar patients.
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