Mixed States: Diagnosis, Assessment and Diagnostic Stability

Psychiatric disorders are among the top causes worldwide of disease burden and disability. A major criterion for validating diagnoses is stability over time. In our clinical practice, we noticed a diagnostic stability using assessment to early identify mixed feaures. Mixed states are often underdiagnosed, with important consequences in terms of worsening prognosis, frequent admission to the hospital, higher suicide risk and poorer quality of life. In order to be diagnosed with the new specifier in the case of major depression/maniac, the new DSM-5 specifier will require the presence of at least three manic/hypomanic symptoms (or depressive in case of maniac episode) that don't overlap with symptoms of major depression. For this reason, we analyzed retrospectively data from patients admitted in the Psychiatric Hospital from January 1st to December 31th 2021 to identify clinical features of the mixed states by administering the G.T.-MSRS scale. Within the 691 subjects of the sample, the large majority (74% of man and 76% of women) met criteria for mixed state; of those only about 34% of man and 31% of women were discharged with a diagnosis of Affective Disorder, however 70% in both man and women were prescribed a mood stabilizer. This study shows that there is a high prevalence of mixed states in the inpatient unit admission, which is demonstrated both from the prescription of mood stabilizers, and confirmed by the diagnosis of mixed states rated with the scale. The scale can be a useful instrument to detect early in the course if the hospitalization the presence of mixed state, in order to guide a tailored psychopharmacological treatment, and improve prognosis.