12/9/2023 0 Comments Acute manic episode![]() Historical developments regarding the concept of mixed phenomena The emerging themes from this endeavor were synthesized in a succinct and applicable style to delineate the modern stance on the etiology, pathogenesis and treatment of mixed affective states in bipolar disorder.ġ. ![]() These were read in full and their reference lists were also consulted. About 100 articles were found to be particularly relevant and were comprised of human and animal studies and review articles, which shed light on the subject from different angles. The abstracts of these articles were read and their pertinence to the topic under discussion was determined. In order to gain a current perspective, papers published in the last 10 years were selected which still numbered over 500 further, it was noticed that the number of publications has increased several fold in the last decade or so. These covered various aspects like causation, clinical characteristics and management. A very large number of citations exceeding 1,000 were retrieved with this strategy which included clinical trials, retrospective and prospective studies, animal experiments, review articles and case reports. In June 2016 the PubMed electronic database was explored using a variety terms, for example “mixed states”, “mixed episode”, “switching”, “rapid cycling” cross-referenced with “bipolar disorder”. Then, the current conceptualizations regarding the etiology and pathogenesis of mixed states are explained, and finally evidence-based treatment options are discussed. ![]() ![]() The strategy adopted in searching the existing literature is first described, followed by a detailed account of the clinical significance of mixed symptoms. A particularly difficult matter in the management of bipolar patients is the occurrence of mixed states and the purpose of the present manuscript is to comprehensively address this issue. The etiopathology of the illness is still unknown and treatments are mainly palliative rather than curative in nature. Negatively influencing the prognosis are such factors as repeated mood episodes, mixed affective symptoms, psychiatric and medical comorbidities. Vast numbers of patients follow a pernicious course, with adverse sequelae in the biopsychosocial realm. It is a prevalent condition and innumerable people are afflicted globally, irrespective of sex, race and geographic location. While the index episode may manifest as melancholic depression, hypomanic or manic exacerbations may occur later on in the course of the disease and are the sine qua non of the diathesis. In conclusion, while progress has been made in the neurobiological understanding of mixed states, the currently available therapeutic modalities have only shown limited effectiveness.īipolar disorder (BD) is a chronic psychiatric ailment with typical onset in adolescence or early adulthood. The management of mixed states is challenging with atypical antipsychotics, newer anticonvulsants and electroconvulsive therapy emerging as the foremost treatment options. Focusing on the most relevant and up to date studies, it was revealed that mixed states result from genetic susceptibility in the circadian and dopamine neurotransmission apparatuses and disturbance in the intricate catecholamine-acetylcholine neurotransmission balance which leads to mood fluctuations. Some exploratory terms utilized included “mixed states”, “mixed episodes”, “switching”, “rapid cycling” cross referenced with “bipolar disorder”. To achieve this goal, in June 2016 an extensive literature search was undertaken using the PubMed database. The purpose of this manuscript is to bring to light the current conceptualizations regarding the etiology, pathogenesis and treatment of mixed states. This paradigm shift reflected their significance in the prognosis and overall management of mood disorders, so that the clinicians should thoroughly familiarize themselves with the contemporary notions surrounding these conditions. In the previous renditions of Diagnostic and Statistical Manual mixed states were narrowly defined in the context of bipolar I disorder, but with the advent of DSM-5 the term “mixed episode” was dropped and replaced by “mixed features” specifier which could be broadly applied to manic, hypomanic and depressive episodes in both the bipolar spectrum and major depressive disorders. Many bipolar disorder patients exhibit mixed affective states, which portend a generally more severe illness course and treatment resistance.
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