Diagnostic Dilemmas and Clinical Correlates of Mixed States in Bipolar Disorder

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Patients with bipolar disorder frequently have varying degrees of mixed states rather than pure episodic manic and depressive episodes. However, DSM-IV-TR and ICD-10 criteria do not fully account for patients’ varying presentations; currently, there is no consensus on whether mixed states is a distinct, categorically different type of mania or whether it is a transitional state between depression and mania. Inconsistent diagnostic criteria can be

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J Clin Psychiatry 2008;69(5):e13