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Depression and Mania in Mixed States

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.

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Figure 1.

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.

Footnotes

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{at}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[CrossRef][Medline]
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[CrossRef][Medline]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Berk, M. Articles by Malhi, G. S. Search for Related Content PubMed Citation Articles by Berk, M. Articles by Malhi, G. S. Bipolar Disorder Depression

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