Psychotic Mixed State: Clinical-Anamnestic and Familial Comparisons with Nonpsychotic Mixed, Psychotic Manic, and Schizoaffective Disorders
An extreme variability and polymorphism in the clinical picture, a frequency of psychotic features, prolonged duration, and resistance to lithium treatment often conceal the affective nature of bipolar mixed episodes, leading to a misdiagnosis of schizophrenia. The extent of the unsolved diagnostic dilemmas is reflected in the latest edition of the formal classificatory systems, DSM-III-R (American Psychiatric Association 1987) and ICD-10 Draft (1989), where the mixed state appears as the vaguest category of mood disorders, with inadequate diagnostic criteria. These criteria do not allow distinction from rapid cycling, nor the recognition of a mixed episode at the onset of bipolar illness; they ignore the low-grade forms and do not encompass the variable and shifting symptomatology, leaving the boundary with most mental disorders, from the neurotic to the schizophrenic, quite fluid. The longitudinal criterion may be useful in many of these conditions: family history, the previous course, characterized by typical mood episodes, usually depressive, alternated with intervals free from psychopathologic symptoms, generally allow the identification of the affective nature and guide us towards a correct interpretation of these forms.
KeywordsBrief Psychiatric Rate Scale Schizoaffective Disorder Manic Episode Psychotic Feature Mixed Episode
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