[Mixed Episodes in Bipolar Disorders--Changes in DSM-5 and Treatment Recommendations]

Area of Science:

• Psychiatry
• Neuroscience
• Pharmacology

Context:

• Mixed episodes in affective disorders pose significant clinical challenges, often leading to complex treatment courses and poorer outcomes, including elevated suicide rates.
• The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) revised the diagnostic criteria, replacing the "mixed episode" diagnosis with "affective episodes with mixed features."
• This diagnostic shift lowers the threshold for identifying these episodes, potentially increasing the number of individuals requiring intervention.

Purpose:

• To review the available literature on the pharmacological treatment of mixed episodes.
• To highlight the diagnostic changes introduced in DSM-5 concerning mixed features.
• To identify effective pharmacological agents for managing these conditions.

Summary:

• The diagnosis of mixed episodes has been updated in DSM-5 to "affective episodes with mixed features," simplifying diagnostic criteria.
• Current literature on treating mixed episodes is limited.
• Pharmacological interventions involving atypical antipsychotics (olanzapine, aripiprazole) and mood stabilizers (valproate, carbamazepine) have demonstrated efficacy.

Impact:

• The revised DSM-5 criteria may lead to earlier identification and intervention for patients experiencing mixed features.
• Understanding effective pharmacological treatments is crucial for improving patient outcomes and reducing the burden of affective disorders.
• Further research is needed to establish robust treatment guidelines for affective episodes with mixed features.