Image
Evidence-Based Best Practices

Mixed Features in Depressive Episodes

Managing Patients Across the Disease Spectrum

Meeting Slides

Guidelines

Diagnostic and Statistical Manual of Mental Disorders (Fifth edition).

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth edition). 2013: Arlington, VA, American Psychiatric Publishing.

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

2016: Arlington, VA, American Psychiatric Publishing.

Clinical Tools

Montgomery-Asberg Depression Rating Scale (MADRS)

This clinician-scored questionnaire assesses the severity of patient depression over the prior week on a scale of 0-6, where 0 denotes no symptoms and 6 indicates the most severe symptoms (Montgomery SA, Asberg M. Brit J Psychiat. 1979;134:382-389).

Young Mania Rating Scale (YMRS)

This clinician-guided assessment is intended to identify the severity of patient abnormalities. The 11-statement assessment is used to describe the patient’s symptoms over the prior week through scoring on a 0-4 scale, where 0 is absence of symptoms (feeling normal) and 4 indicates the most severe symptoms (Young RC, et al. Br J Psychiatry. 1978;133(5):429-435).

Clinically Useful Depression Outcome Scale with questions for the DSM-5 mixed features specifier (CUDOS-M)

This self-administered assessment scale detects the presence of mixed features in patients with major depressive disorder. With a rating scale of 0-4, where 0 is not at all true and 4 is almost always true, patients endorse the frequency of each symptom experienced during the prior week (Zimmerman M, et al. J Affect Disord. 2014;168:357-362).

Patient Resource

Depression and Bipolar Support Alliance

The Depression and Bipolar Support Alliance (DBSA) offers resources for patients, materials for clinicians, information on mental health research as well as listings of patient support groups across the United States

Suggested Readings

Mixed specifier for bipolar mania and depression: highlights of DSM-5 changes and implications for diagnosis and treatment in primary care.

Hu J, et al. Prim Care Companion CNS Disord. 2014;16(2).

Heterogeneity of DSM-IV Major Depressive Disorder as a Consequence of Subthreshold Bipolarity

Zimmermann P, et al. Arch Gen Psychiatry. 2009;66(12):1341-1352.

A 6 Week Randomized Double-Blind Placebo-Controlled Trial of Ziprasidone for the Acute Depressive Mixed State.

Patkar A, et al. Plos ONE. 2012;7(4):e34757.

The prevalence and illness characteristics of DSM-5-defined "mixed feature specifier" in adults with major depressive disorder and bipolar disorder: Results from the International Mood Disorders Collaborative Project.

McIntyre RS, et al. J Affect Disord. 2014;12(172C):259-264.

Efficacy of olanzapine monotherapy in the treatment of bipolar depression with mixed features.

Tohen M, et al. J Affect Disord. 2014;164:57-62.

Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study.

Perugi G, et al. J Clin Psychiatry. 2015;76(3):e351-e358.

Lurasidone in the treatment of bipolar depression with mixed (subsyndromal hypomanic) features: post hoc analysis of a randomized placebo-controlled trial.

McIntyre RS, et al. J Clin Psychiatry. 2015;76(4):398-405.

Activity
Mixed Features in Depressive Episodes

Managing Patients Across the Disease Spectrum

Relevant Resources

Reducing the Burden of Bipolar Depression

Improved Diagnostic and Management Strategies

Improving Outcomes in Bipolar Depression

Overcoming Diagnostic Challenges, Targeting Remission, and Optimizing Cardiometabolic Health

Comprehensive Management of Bipolar Depression

New Approaches to Optimizing Patient Outcomes

A Focus on Bipolar Depression

Overcoming Diagnostic Barriers and Optimizing Long-Term Patient Outcomes

Multidisciplinary Management of Bipolar Disorder

Accelerating Diagnosis, Achieving Remission, and Encouraging Adherence

Agitation and Psychiatric Disease

Best Practices for Emergency Care

Clinical Issues in Bipolar Depression

Consensus and Controversies Across the Spectrum of Patient Presentations