0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Images in Psychiatry   |    
Depression and Mania in Mixed States
Michael Berk, M.D.; Seetal Dodd, Ph.D.; Gin S. Malhi, M.D.
Am J Psychiatry 2006;163:1160-1160. doi:10.1176/appi.ajp.163.7.1160

These exquisite images by gifted Australian artist Deirdre Oliver illustrate beautifully the spectral admixture of depression and mania seen in mixed states, graphically distilling the essence of the subjective experience while simultaneously depicting a clinically critical issue. Together, the two images depict mirror perspectives, namely, the euphoria of mania encircled by depression (top) and the melancholy of depression surrounded by a penumbra of mania (bottom). These pictures capture the clinical breadth of this phenomenon and contrast with the DSM view that necessitates concurrence of full manic and depressive presentations.

There has been an emerging consensus that mixed states are common (1) and frequently underrecognized (2). These occur on a spectrum of severity between DSM-IV-TR criteria and pure episodes, but better diagnosis is necessary because they are likely to require differential management and may have poorer prognosis in comparison to more pristine phases.

1.Dilsaver SC, Benazzi F, Akiskal HS: Mixed states: the most common outpatient presentation of bipolar depressed adolescents? Psychopathology 2005; 38:268–272
 
2.Berk M, Dodd S, Malhi GS: “Bipolar missed states”: the diagnosis and clinical salience of bipolar mixed states. Aust NZ J Psychiatry 2005; 39:215–221
 

+Address correspondence and reprint requests to Dr. Dodd, University of Melbourne, Clinical and Biomedical Sciences–Barwon Health, P.O. Box 281, Geelong, Victoria, Australia 3220; seetald@barwonhealth.org.au (e-mail).

 
+

References

1.Dilsaver SC, Benazzi F, Akiskal HS: Mixed states: the most common outpatient presentation of bipolar depressed adolescents? Psychopathology 2005; 38:268–272
 
2.Berk M, Dodd S, Malhi GS: “Bipolar missed states”: the diagnosis and clinical salience of bipolar mixed states. Aust NZ J Psychiatry 2005; 39:215–221
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 2.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 11.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 17.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 17.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 44.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles