Importance of a Correct Initial Diagnosis and Stabilization to Avoid Social and Economic Consequences
J Clin Psychiatry 2007;68(9):e22
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with bipolar disorder often present with both manic and depressive symptoms,
which can be confused with symptoms of other psychiatric illnesses or missed
altogether in clinical diagnoses. The key concept in understanding these bipolar mixed states is that
mood, cognition, and psychomotor energy may change independently of each other,
which may result in the superimposition of an extreme pure mood state onto
cognitive or psychomotor features of the opposite mood state. The DSM-IV-TR
includes a categorical and limited definition of mixed states, whereas other
concepts focus on dimensional mixing and trait mixing. This variation in
criteria for mixed episodes may create diagnostic dilemmas concerning patients who
present with both manic and depressive symptoms. Therefore, firm criteria must
be established so that clinicians can accurately diagnose and treat patients in
mixed episodes to reduce mortality and promote optimal outcomes.
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