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Mixed Forms in Bipolar Disorder and Relation to Gender

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Psychopathology in Women

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Abstract

Mixed states describe the simultaneous presence of manic and depressive symptoms in the same patient. This phenomenon is more prevalent in women. Activation, thinking, and mood are combined in a strange form, being possible that some of these three dimensions are increased from the euthymic period, while others are decreased. It is quite common presentation of irritable mood, with rapid thinking, suicidal ideas, anxiety, helplessness, and sexual disinhibition. Sometimes there are variations in the clinical presentation in the same day.

There are some depressive symptoms present in the mixed states that are more relevant for the diagnosis: depressed mood, guilt, suicidal ideation, anhedonia, and fatigue. Irritable mood and psychotic symptoms are also frequently present in mixed states.

One aspect that is relevant for the prognosis of mixed states is the earlier age at onset. The younger age at onset and the delay in the diagnosis explain partially, but not all the differences in prognosis of this severe disease. These patients are also in higher risk of drug and alcohol abuse.

Actually DSM-V has included partially this aspect and has considered the diagnosis of mixed symptoms as specifier of mania, hypomania, bipolar depression, and moreover, unipolar depression. The special follow-up of those patients with unipolar major depression and three manic symptoms is actually diagnosed as major depression with mixed symptoms. A careful follow-up should be done in those patients in order to consider a bipolar disorder in the future.

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Authors and Affiliations

  1. University of the Basque Country UPV/EHU, Leioa, Spain

    Ana González-Pinto, Purificación López Peña & Saioa López-Zurbano

  2. Alava University Hospital-Santiago, Vitoria, Spain

    Ana González-Pinto, Maddi Laborde Zufiaurre, Beatriz González Hernández, Purificación López Peña, Ana Isabel Cano & Saioa López-Zurbano

  3. CIBERSAM, Barcelona, Spain

    Ana González-Pinto

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  1. Ana González-Pinto
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  2. Maddi Laborde Zufiaurre
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  3. Beatriz González Hernández
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  4. Purificación López Peña
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  5. Ana Isabel Cano
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  6. Saioa López-Zurbano
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Correspondence to Ana González-Pinto .

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  1. Cruces University Hospital, University of the Basque Country, Barakaldo, Vizcaya, Spain

    Margarita Sáenz-Herrero

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González-Pinto, A., Laborde Zufiaurre, M., González Hernández, B., López Peña, P., Cano, A.I., López-Zurbano, S. (2019). Mixed Forms in Bipolar Disorder and Relation to Gender. In: Sáenz-Herrero, M. (eds) Psychopathology in Women. Springer, Cham. https://doi.org/10.1007/978-3-030-15179-9_32

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