J Korean Neuropsychiatr Assoc.  2006 Jul;45(4):337-342.

Re-evaluation of Bipolar Patients Hospitalized for Manic Episode: Possibility of Diagnosing as a Mixed Episode

• Jon DI
• Kim KR
• Lee E
• Son SJ

Abstract

OBJECTIVE
Mixed states are difficult to define precisely and to recognize accurately. Moreover, the DSM-IV criteria for diagnosis of a mixed episode might be too restrictive. The purpose of this study was to investigate the possibility of a mixed episode in bipolar inpatients hospitalized with DSM-IV manic episodes using the Cincinnati criteria, which is a broader criteria compared to DSM-IV.
METHODS
Inpatient charts of manic patients were carefully evaluated to determine the presence of depressive symptoms in the Cincinnati criteria. The probable mixed patient group was compared with the definitely manic patient group on demographic and clinical variables. The predictability of depressive symptoms for a mixed episode was assessed.
RESULTS
Twenty-one out of 101 manic inpatients were possibly diagnosed as mixed episodes. They showed more psychiatric family history, comorbid personality disorder and suicide attempts. Two symptoms (suicidal ideation and helplessness or hopelessness) had good positive predictive value.
CONCLUSION
Diagnosis of a mixed episode can be increased with careful interview and by using a broader diagnostic criteria. The presence of suicidal ideation and helplessness or hopelessness may suggest a mixed state.

Keyword

Bipolar disorder; Mixed episode; Re-evaluation; Diagnosis; Cincinnati criteria

MeSH Terms

Bipolar Disorder
Depression
Diagnosis
Diagnostic and Statistical Manual of Mental Disorders
Humans
Inpatients
Personality Disorders
Suicidal Ideation
Suicide