What exactly is that? There were some questions about it in an ADHD/ADD thread and I thought the topic should be given it's own thread, since it has nothing to do with ADHD/ADD. It is related to bipolar disorder and is the combination of symptoms of both mania and depression. According to Wikipedia, the DSM IV recongizes a "mixed episode" if the critera for depression and mania is met every day for at least one week. Here is the link: http://en.wikipedia.org/wiki/Mixed_state_(psychology) Savy? Peace and love
I remain convinced that you cannot have a Manic and a Major Depressive Episode at the same time. Lets look at some of the diagonostic critera: decreased need for sleep (e.g., feels rested after only 3 hours of sleep) vs. fatigue or loss of energy nearly every day inflated self-esteem or grandiosity vs. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproachor guilt about being sick) more talkative than usual or pressure to keep talking vs. clinically significant distress or impairment in social, occupational, or other important areas of functioning. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) vs. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others.) These are clearly polar opposites. Now what does the DSM say about Mixed Episodes? The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1 week period. Not that they happen at the same time, but during the same day (ie: it specifically mentions that the length requirement does not have to be met for a Major Depressive Episdoe). I stand by my previous argument that you cannot be both Manic and Majorly Depressed at the same time.
As someone who has had a mixed episode, here are some symptoms that present themselves in myself personally. Manic: lack of sleep, speeded thinking, speeded talking, halluncinations, delusions. Depression: Feelings of inadiquacy, suicidal thoughts, lack of interest in anything. "People having MIXED EPISODES may feel sad, hopeless, and suicidal as well as extremely energized... Mixed episodes involve both depression and mania nearly every day for at least one consecutive week. People in mixed episodes may be particularly in danger because they have enough energy to act on any suidical feelings." -Bipolar Disorder Demystified, by Lana Castle. Why don't you google mixed episodes? It's a well known fact of bipolar disorder. I'll post more links that you can check out (if you choose to): http://bipolar.about.com/od/mixedepisodes/Mixed_Episodes.htm (not a great one) http://www.behavenet.com/capsules/disorders/mixedep.htm (check this one out) Peace and love
Feeling energized isn't Mania. There is a list of symptoms you have to meet - the ones I listed are quoted directly out of the DSM IV. Nearly every one with a polar opposite symptom. Cite me an academic, peer-reviewed source - I'll check it out. Somehow about.com and behavenet.com don't strike me as the be all and end all. I just checked out your second source - it mentions nothing except that they must happen in the same day. It says nothing about them happening simultaneously.
The DSM is lacking in defining a mixed state. There's lots of ongoing debate over a precise definition. It even goes beyond bipolar, since so many people with major depressive disorder also report the symptoms. The MMDT (Merck Manual for Diagnosis and Therapy) is a little clearer in defining a mixed episode. Mixed state: A mixed episode blends depressive and manic or hypomanic features. The most typical examples are momentary switches to tearfulness during the height of mania or racing thoughts during a depressive period. In at least 1/3 of people with bipolar disorder, the entire episode is mixed. A common presentation consists of a dysphorically excited mood, crying, curtailed sleep, racing thoughts, grandiosity, psychomotor restlessness, suicidal ideation, persecutory delusions, auditory hallucinations, indecisiveness, and confusion. This presentation is called dysphoric mania (ie, prominent depressive symptoms superimposed on manic psychosis). http://www.merck.com/mmpe/sec15/ch200/ch200c.html#sec15-ch200-ch200c-552 Good articles on mixed states: Kraepelin’s Manic-depressive Insanity and Paranoia. 1921 McElroy’s “Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania”. Am J Psychiatry. 1992 Perugi’s “Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases.” J Affect Dis. 1997 From Akiskal’s “Complex Bipolarity: Focus on Temperament and MixedStates” In his original description, Kraepelin observed that in a mixed state, 1 or more of the main features of mania is replaced by 1 or more of the main features of depression, and vice versa. This approach led him to postulate 6 putative mixed state subtypes, 3 of which are of the greatest interest to us today: (1) depression with flight of ideas, (2) excited depression, and (3) depressive-anxious mania. In addition, Kraepelin described some specific characteristics of mixed state, such as the tendency to pursue a protracted course and the frequent presence of psychotic features. Two aspects of Kraepelin's concept of mixed state are particularly noteworthy for this discussion. First, mania with just a few depressive signs or symptoms qualifies for a mixed-manic diagnosis. More importantly, Kraepelin explicitly described depressive mixed states as consisting of full-fledged depressions with isolated manic admixtures, a condition completely ignored in DSM-IV.
