Clinical subtypes of bipolar mixed states:: Validating a broader European definition in 143 cases

摘要: Abstract Objective: To validate and clinically characterize mixed bipolar states derived from the concepts of Kraepelin Vienna School defined as sustained instability affective manifestations opposite polarity — that usually fluctuate independently one another in setting marked emotional perplexity. Method: Our criteria for represent a modified “user-friendly” operationalization these classical concepts. We compared 143 state patients, so defined, with 118 DSM III-R manic systematically evaluated Semistructured Interview Depression (SID) our in-patient day-hospital facilities. Results: The two groups were comparable demographic familial standpoints (including family history disorder). Mixed predominant past index patients who more likely to have experienced stressors attempted suicide; hypomanic episodes common who, addition, had hospitalizations. Although rates chronicity rapid cycling not significantly different groups, modal 3–6 months, mania they less than 3 months. Two thirds both arose dysregulated baseline temperamental dysregulation, which, manics, was largely hyperthymic, hyperthymic depressive. Of states, only 54% met (which conformed “dysphoric mania”); remaining, 17.5% could be described “mixed agitated psychotic depressive states” irritable mood flight ideas, 26% “unproductive–inhibited manic” fatigue indecisiveness. course “non-DSM III-R” essentially similar states. Limitation: Family obtained blind clinical status severe Clinical Relevance: These data favor European approach over grossly under-inclusive current official diagnostic systems. Conclusion: phenomenology is mere superposition symptoms and, many instances, it represents an expansive–excited phase intruding into temperament, melancholic episode temperament.