[Dysphoric mania and mixed states]

Mixed states and depressive or dysphoric mania have been described by Kraepelin at the beginning of the century. They recently became the focus of interest and research. This type of bipolar disorder is frequent (30-40%), severe, difficult to treat. They can be associated with neurological and developmental disorders, substance abuse and other conditions. These patients are less responsive to lithium than patients with pure mania. Anticonvulsant drugs appear to be more efficacious. They can be prescribed with lithium. ECT proved to be useful in case of non response. The nature of these conditions is still a matter of discussion: protracted transitional state or mood switch, association with ultra-rapid cycling, or rather superimposition of two psychopathologies and physiopathogeny of mania and depression.