The article you requested is

Importance of a Correct Initial Diagnosis and Stabilization to Avoid Social and Economic Consequences

J Clin Psychiatry 2007;68(9):e22

Patients 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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