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13-06-2013 | Mental health | Article

DSM-5 mixed specifier in manic episodes endorsed


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medwireNews: Study findings showing depressive features are common during manic episodes in patients with bipolar disorder support the validity of the DSM-5 specifier of "mixed features" in such patients.

The DSM-5 mixed specifier supplants the DSM-IV-TR definition of mixed episodes and applies in episodes where subthreshold or syndromal symptoms from the opposing pole are present during a full mood episode.

In the current study, the researchers looked at features of depression during manic episodes in post-hoc analyses of 960 patients. Of these, approximately one-third met the DSM-5 definition of mania with mixed specifier.

Specifically, 34.2% had scores of at least 1 for depressed mood, fatigue/loss of energy, worthlessness/guilt feelings, and suicidal thoughts on the Montgomery-Åsberg Depression Rating Scale (MADRS) and a score of at least 2 for psychomotor retardation on the Positive and Negative Syndrome Scale (PANSS).

Of the remaining participants, 17.5% scored at least 2 for the three MADRS depressive features and at least 3 for the PANSS depressive feature, while 4.3% scored at least 3 and 4, respectively.

This frequency suggests that the "DSM-5 definition of mixed features is more reflective of what is encountered in clinical practice," say the researchers, led by Roger McIntyre (University of Toronto, Ontario, Canada).

The occurrence of depressive features affected remission rates, with depressive symptom remission decreasing with increasing severity in patients with at least two or three depressive features.

The remission of manic symptoms remained stable across all severity levels, except in patients with at least three depressive features in whom remission rates were highest for the most severe patients.

The researchers also point out in the Journal of Affective Disorders that their results indicate that "agents proven effective in mania… are not similarly effective in reducing both manic and depressive symptom severity in individuals meeting the DSM-5 mixed specifier criteria."

The therapeutic profile of an anti-manic agent would therefore need to be considered in terms of its capability of mitigating both manic and depressive symptoms, they say.

"The results herein underscore the multidimensional symptom structure of mania, and also indicate that the efficacy of anti-manic agents in DSM-IV-defined acute mania cannot be extrapolated in individuals meeting criteria for DSM-5-defined mixed specifier," the researchers conclude.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter

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