What’s a mixed episode?

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A mixed episode is a psychiatric state in which someone experiences symptoms of both mania and depression at the same time. Diagnostic manuals used to define diagnoses for psychiatric purposes, such as the Diagnostic and Statistical Manual Mental Disorders, published by the American Psychiatric Association, have very strict definitions for mixed episodes. Many people who experience states that are clearly mixed in nature are not diagnosed with mixed episodes because they fall outside the narrow diagnostic criteria, and this can make treatment very challenging.

To officially be considered a mixed episode, a patient must be experiencing major depression and mania concurrently for at least one week. This state is more common in people with bipolar I, a psychiatric disorder characterized by periodic episodes of mania or depression. The mixed state can manifest itself in several ways. People may have agitated depression or dysphoric mania, with racing thoughts, agitation, and extreme depression, including suicidal thoughts and flat affect.

This combination of manic and depressive symptoms can be extremely dangerous. Patients experiencing mixed episodes are at increased risk of suicide, self-harm and other psychiatric complications. It is not uncommon for patients to require hospitalization for treatment. Self-care and completing daily tasks can become difficult and sometimes impossible. Patients may forget to eat and practice basic hygiene and may become antisocial as they struggle with the conflicting thoughts they are experiencing.

Medications designed to stabilize mood can be used in the treatment of a mixed episode. These drugs must be prescribed carefully because some patients may react poorly to certain drugs, experiencing more severe symptoms rather than relief. Psychotherapy is helpful for some patients once stabilized on medications, and other treatments may also be explored, depending on the specifics of a particular case.

Patients with a history of mental illness can be aware of the warning signs of a mixed episode and can take steps to receive treatment before symptoms become severe. In other cases, patients may not recognize the onset or may not have experienced such episodes before, and therefore may not be prepared for them. It is very important that patients receive treatment while they are experiencing mixed episodes because this state can be extremely dangerous. Even if a patient does not meet diagnostic criteria because the state is too short or hypomania is experienced instead of mania, there are serious risks associated with experiencing both mania and depression simultaneously in a mixed episode.

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