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

J. Sloan Manning, MD, and Rakesh Jain, MD

Published: September 17, 2007

Article Abstract

Patientswith bipolar disorder often present with both manic and depressive symptoms,which can be confused with symptoms of other psychiatric illnesses or missedaltogether in clinical diagnoses. The key concept in understanding these bipolar mixed states is thatmood, cognition, and psychomotor energy may change independently of each other,which may result in the superimposition of an extreme pure mood state ontocognitive or psychomotor features of the opposite mood state. The DSM-IV-TRincludes a categorical and limited definition of mixed states, whereas otherconcepts focus on dimensional mixing and trait mixing. This variation incriteria for mixed episodes may create diagnostic dilemmas concerning patients whopresent with both manic and depressive symptoms. Therefore, firm criteria mustbe established so that clinicians can accurately diagnose and treat patients inmixed episodes to reduce mortality and promote optimal outcomes.

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