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Bipolar disorder - Management
When should I suspect a mixed episode?
- A mixed episode is suggested by a mixture, or rapid alternation (usually within a few hours), of manic/hypomanic and depressive symptoms.
- Both sets of symptoms should be prominent for the greater part of the current episode of illness.
Basis for recommendation
- This recommendation is based on the National Institute for Health and Clinical Excellence (NICE) guideline Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care [NICE, 2006].
- This definition of a mixed episode is similar to the International classification of disease (ICD-10) [WHO, 1992], whereas the Diagnostic and statistical manual of mental disorders describes a mixed episode as:
- A period of time (at least 1 week) in which the criteria are met both for a manic episode and for a depressive episode (except for duration) nearly every day, and which is sufficiently severe to cause marked impairment of occupational functioning, or to require hospitalization, or there are psychotic features [DSM-IV, 1994].
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