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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by icu_baby on October 20, 2011, at 1:59:35
Hi All,
I have been diagnosed with "mixed affective states". My psychiatrists told me that I was depressed with agitation and psychotic features.
He also says that I don't have bipolar disorder, yet other psychiatrists state that it is a state in bipolar disorder. Is it a separate entity or part of bipolar 1 or 2?
I want to know what are the symptoms of a mixed state is precisely?
The DSM only describes it as as symptoms of mania and depression occurring simultaneously. It does not give any detail of the symptoms.
I have been researching the internet for months but I can't find any reliable sources as to what this state is.
One source described it as "less need for sleep, talking fast, recklessness/impulsive irritable"
Another source: "agitation, irritability, anxiety, distractibility, racing thoughts"
and from Wikipedia a mixed state is: "agitation, anxiety, aggressiveness, confusion, pressured speech, racing thoughts, restlessness and rage"
What are the correct symptoms of a mixed affective state/dysphoric mania in bipolar disorder and is it part of bipolar 1 or bipolar 2 or a separate diagnosis on its own?
Thanks so much in advance for your help.
Posted by creepy on October 20, 2011, at 2:48:21
In reply to Mixed states/dsyhoric mania in Bipolar Disorder, posted by icu_baby on October 20, 2011, at 1:59:35
Mixed states can occur outside of bipolar. Youve pretty much summed up what it is. Depression with hypomania. Irritability, anger.
Things like road rage, or stub your toe on a sofa and start violently kicking the sofa in a fit of anger.
If you have psychotic features with depression, those might resolve if you treat the depression. If it comes with the hypomanic component you may do better on an AAP or mood stabilizer.
Zoloft seems to work well on mild mixed depression / irritability for me. Several other ADs have made it worse.
PTSD can look like this too, because of the hyperarousal and depression that take place.
Posted by icu_baby on October 20, 2011, at 3:26:09
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by creepy on October 20, 2011, at 2:48:21
> Mixed states can occur outside of bipolar. Youve pretty much summed up what it is. Depression with hypomania. Irritability, anger.
> Things like road rage, or stub your toe on a sofa and start violently kicking the sofa in a fit of anger.
> If you have psychotic features with depression, those might resolve if you treat the depression. If it comes with the hypomanic component you may do better on an AAP or mood stabilizer.
> Zoloft seems to work well on mild mixed depression / irritability for me. Several other ADs have made it worse.
> PTSD can look like this too, because of the hyperarousal and depression that take place.
>
>Thanks creepy, its just that the DSM doesn't specify the symptoms. Like you pointed out the euphoria of mania is not there but irritability and anger is.
Posted by g_g_g_unit on October 20, 2011, at 3:48:39
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by icu_baby on October 20, 2011, at 3:26:09
yeah, I'm kinda confused atm. because I experience something similar, mainly in reaction to stimulants. sure, they improve my alertness and concentration, but I'm willing to pretty much annihilate anyone who even slightly annoys me; they make me hate the entire world.
I don't experience racing thoughts or euphoria. just that overwhelming vitriol
Posted by Phillipa on October 20, 2011, at 10:47:40
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by g_g_g_unit on October 20, 2011, at 3:48:39
Could it be possible you are angry at something in life and take the anger out in actions? Simple I know. As I know when angry I will kick things but not bipolar and yes my thoughts skip from one thing to the other. Phillipa
Posted by creepy on October 20, 2011, at 14:06:33
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by g_g_g_unit on October 20, 2011, at 3:48:39
Thats weird, and Ive heard several other people say they have the same reaction to stims. When I take them I just get anxious.
I wonder if taking them with a beta blocker to negate the NE effects might help? Or taking dexedrine instead of adderall?
Posted by Christ_empowered on October 20, 2011, at 19:39:54
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by creepy on October 20, 2011, at 14:06:33
I've gotten the same diagnosis. Antidepressants made it worse, anticonvulsants were only minimally helpful, and stimulants at higher doses triggered psychosis. I've also experienced psychotic depression at a young age, which is a warning sign for potential bipolar I. I switched from psychotic depression into a psychotic break (agitation, delusions, paranoia, hallucinations). I'm now diagnosed as Bipolar I w/ Psychotic Features.
I don't know that diagnosis is all that important. You'll probably be put on some kind of tranquilizer (antipsychotic most likely, but benzos can also be used) plus a mood elevator (antidepressant and/or lamictal). Depakote is another possibility (I'd avoid it if I were you). Lithium is OK for depression, but not so great for mixed states. It can help psychotic depression, if you want to avoid an antipsychotic.
So, basically, you'll probably be treated with drugs used for bipolar and/or schizophrenia. I'd be wary of antidepressants and stimulants.
Posted by icu_baby on October 20, 2011, at 19:48:11
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by Christ_empowered on October 20, 2011, at 19:39:54
Thanks empowered. I am sorry you are diagnosed with psychosis. That must be scary. I was told that I have paranoid ideation. Yes antidepressants can make a mixed state worse.
I was put on lithium and olanzapine. I don't know why they didn't put me on an anti-convulsant since that has better efficacy than lithium.
Maybe I shouldn't try and understand the symptoms and just get better. There is little research done on mixed states despite the fact that it is more chronic, has poorer prognosis and has high suicidal risk.
Posted by creepy on October 20, 2011, at 21:39:27
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by icu_baby on October 20, 2011, at 19:48:11
Id try to get off of zyprexa once you stabilize. Or at the very least ask for metformin to go with it so you dont have issues with blood sugar control later on
Posted by Christ_empowered on October 20, 2011, at 22:28:23
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by creepy on October 20, 2011, at 21:39:27
yeah, I don't get the lithium+zyprexa thing either. Lithium can make side effects from antipsychotics worse. But, whatever--I'm sure you doc(s) had reason to choose this combo.
I hope you get better soon. Dropping the zyprexa, or lowering the dose, might be a good idea. I would say try Abilify or Geodon (weight issues), but zyprexa is more sedating and both of the more weight-neutral options have a problem with activation/stimulation. Probably not what you're after.
Good luck.
Posted by morgan miller on October 20, 2011, at 23:46:53
In reply to Mixed states/dsyhoric mania in Bipolar Disorder, posted by icu_baby on October 20, 2011, at 1:59:35
> Hi All,
>
> I have been diagnosed with "mixed affective states". My psychiatrists told me that I was depressed with agitation and psychotic features.
>
> He also says that I don't have bipolar disorder, yet other psychiatrists state that it is a state in bipolar disorder. Is it a separate entity or part of bipolar 1 or 2?
>
> I want to know what are the symptoms of a mixed state is precisely?
>
> The DSM only describes it as as symptoms of mania and depression occurring simultaneously. It does not give any detail of the symptoms.
>
> I have been researching the internet for months but I can't find any reliable sources as to what this state is.
>
> One source described it as "less need for sleep, talking fast, recklessness/impulsive irritable"
>
> Another source: "agitation, irritability, anxiety, distractibility, racing thoughts"
>
> and from Wikipedia a mixed state is: "agitation, anxiety, aggressiveness, confusion, pressured speech, racing thoughts, restlessness and rage"
>
> What are the correct symptoms of a mixed affective state/dysphoric mania in bipolar disorder and is it part of bipolar 1 or bipolar 2 or a separate diagnosis on its own?
>
> Thanks so much in advance for your help.The correct symptoms are all of the above listed.
I'm not sure your doctor can definitively say what it is, sounds like it could be bipolar.
Could you tell us some about your history? Have you ever been manic at all? Overly happy, slightly euphoric, hyperactive, impulsive, unusually high energy, wild behavior, risky behavior???? Any of these or several at one time?
Do you go through depressive periods?
Do stressful events trigger your episodes?
Morgan
Posted by morgan miller on October 20, 2011, at 23:53:30
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by Christ_empowered on October 20, 2011, at 22:28:23
I think a good combination for many suffering these symptoms can be Depakote+low dose Lexapro or Zoloft+low dose Lithium. Just a moderate amount of Depakote-750mg-along with a low dose of Lexapro-2.5mg-can go a long way in improving mixed states. Start of with the Depakote for a month, then add in the Lexapro if necessary. I think for the depressive side the Lexapro, or even Zoloft at 25 mg, will be necessary for treating the depressive symptoms, and relieving anxiety.
Morgan
Posted by icu_baby on October 21, 2011, at 0:39:33
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by morgan miller on October 20, 2011, at 23:46:53
Posted by Phidippus on October 21, 2011, at 14:00:21
In reply to Mixed states/dsyhoric mania in Bipolar Disorder, posted by icu_baby on October 20, 2011, at 1:59:35
> I have been diagnosed with "mixed affective states". My psychiatrists told me that I was depressed with agitation and psychotic features.
Psychotic Major Depression can present with psychomotor agitation and psychotic features
> He also says that I don't have bipolar disorder, yet other psychiatrists state that it is a state in bipolar disorder. Is it a separate entity or part of bipolar 1 or 2?
PMD (psychotic major depression) is a unique diagnosis, but the condition can be comorbid with a bipolar diagnosis.
> I want to know what are the symptoms of a mixed state is precisely?
A mixed state presents with bipolar disorder and is marked by depression and mania occuring at the same time. Imagine getting really depressed, but at the same time having symptoms of mania: racing thoughts, distractability, pressured speech, etc. This is a dangerous state, as symptoms of rage and suicidiality can often come with it. DSM-IV defines a mixed state as meeting full criteria for a manic and a major depressive episode, for at least one week.
> The DSM only describes it as as symptoms of mania and depression occurring simultaneously. It does not give any detail of the symptoms.
Look up the DSM-IV citeria for a manic episode and then for major depressive episode - these symptoms combine to make up a mixed state.
> I have been researching the internet for months but I can't find any reliable sources as to what this state is.
I have had mixed states. Here are the symptoms I experienced: psychomotor agitation, feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick), diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others), recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide, flight of ideas or subjective experience that thoughts are racing, distractability, decreased need for sleep, Insomnia
Mania symptoms: http://www.biologicalunhappiness.com/ManiaDSM.htm
Major depressive episode:
http://www.mental-health-today.com/dep/dsm.htm> What are the correct symptoms of a mixed affective state/dysphoric mania in bipolar disorder and is it part of bipolar 1 or bipolar 2 or a separate diagnosis on its own?
See above - mix up symptoms from DSM-IV for manic episode with DSM-IV criteria for major depressive episode
I hope this helps
Eric
Posted by icu_baby on October 21, 2011, at 14:56:20
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder » icu_baby, posted by Phidippus on October 21, 2011, at 14:00:21
> > I have been diagnosed with "mixed affective states". My psychiatrists told me that I was depressed with agitation and psychotic features.
>
> Psychotic Major Depression can present with psychomotor agitation and psychotic features
>
> > He also says that I don't have bipolar disorder, yet other psychiatrists state that it is a state in bipolar disorder. Is it a separate entity or part of bipolar 1 or 2?
>
> PMD (psychotic major depression) is a unique diagnosis, but the condition can be comorbid with a bipolar diagnosis.
>
> > I want to know what are the symptoms of a mixed state is precisely?
>
> A mixed state presents with bipolar disorder and is marked by depression and mania occuring at the same time. Imagine getting really depressed, but at the same time having symptoms of mania: racing thoughts, distractability, pressured speech, etc. This is a dangerous state, as symptoms of rage and suicidiality can often come with it. DSM-IV defines a mixed state as meeting full criteria for a manic and a major depressive episode, for at least one week.
>
> > The DSM only describes it as as symptoms of mania and depression occurring simultaneously. It does not give any detail of the symptoms.
>
> Look up the DSM-IV citeria for a manic episode and then for major depressive episode - these symptoms combine to make up a mixed state.
>
> > I have been researching the internet for months but I can't find any reliable sources as to what this state is.
>
> I have had mixed states. Here are the symptoms I experienced: psychomotor agitation, feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick), diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others), recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide, flight of ideas or subjective experience that thoughts are racing, distractability, decreased need for sleep, Insomnia
>
> Mania symptoms: http://www.biologicalunhappiness.com/ManiaDSM.htm
>
> Major depressive episode:
> http://www.mental-health-today.com/dep/dsm.htm
>
> > What are the correct symptoms of a mixed affective state/dysphoric mania in bipolar disorder and is it part of bipolar 1 or bipolar 2 or a separate diagnosis on its own?
>
> See above - mix up symptoms from DSM-IV for manic episode with DSM-IV criteria for major depressive episode
>
> I hope this helps
>
> EricDear Eric, thank you so much for your post. I too have suffered the symptoms you describe and I have to say it definitely is a dangerous state to be in. I am lucky that I am still here because many a times I have attempted suicide while in this state and ended up on life-support. Because it itsn't pure mania or pure depression it is easy for health care workers to know that you are severely ill.
Can you please tell me where you got the information for the first description?
regrads,
Icu_baby
Posted by Phidippus on October 21, 2011, at 15:36:07
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by icu_baby on October 21, 2011, at 14:56:20
Quote me the first description.
Eric
Posted by icu_baby on October 21, 2011, at 16:01:42
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder » icu_baby, posted by Phidippus on October 21, 2011, at 15:36:07
> Quote me the first description.
>
> EricHI Eric, I think I got some of it from Wikipedia which is not a reliable source. Anyway, I have googled "mixed states AND bipolar disorder" and went through 78 of googles search page which was exhausting. Most have a variation of what I have written. I read some abstracts of journal articles and medical sites and there are some papers that criticize the current DSM for being vague and not specifying which manic and depressive symptoms make up a mixed state and what is the minimum amount needed to make up the DSM. In the DSM it says you need a full blown mix of depression and mania but in practise a mixed episode is diagnosed with major depression plus 3 manic features and vice versa. Hopefully the DSM in 2012 will be more helpful.
Posted by B2chica on October 27, 2011, at 8:26:39
In reply to Re: Mixed states/dsyhoric mania in Bipolar Disorder, posted by icu_baby on October 21, 2011, at 16:01:42
the definitions really are very unspecific right now and are really not that acurate. They are in the process of revising the DSM. i think it will be out may of 2013.
There is something going around called the "Bipolarity-Specifier Criteria" it is not a standard of use...yet but it seems to make more sense.
here is the Criteria:-Episode of elevated or irritable mood or an episode of increased activity
-at least 3 of the symptoms listed under Criterion B of the DSM-IV-TR (ie, inflated self-esteem/grandiosity, decreased need for sleep, more talkative, flight of ideas/racing thoughts, distractibility, increase in goal-directed activty/psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences)
associated with at least 1 of the 3 following consequences:
*unequivocal and observable change in functioning uncharacteristic of the persons usual behavior
*marked impairment in social or occupational functioning observable by others
*requiring hospitalization or outpatient treatment-no minimum duration of symptoms is required
-no exclusion criteria
-bipolar-specifier criteria include all cases meeting DSM-IV criteria for bipolar 1 and 2 disorders as well as additional cases excluded by DSM-IV exclusionary criteria (eg, symptoms occuring during antidepressant treatment)
b2c.
Posted by icu_baby on November 3, 2011, at 23:43:22
In reply to Bipolarity-Specifier Criteria......NEW, posted by B2chica on October 27, 2011, at 8:26:39
> the definitions really are very unspecific right now and are really not that acurate. They are in the process of revising the DSM. i think it will be out may of 2013.
>
> There is something going around called the "Bipolarity-Specifier Criteria" it is not a standard of use...yet but it seems to make more sense.
> here is the Criteria:
>
> -Episode of elevated or irritable mood or an episode of increased activity
>
> -at least 3 of the symptoms listed under Criterion B of the DSM-IV-TR (ie, inflated self-esteem/grandiosity, decreased need for sleep, more talkative, flight of ideas/racing thoughts, distractibility, increase in goal-directed activty/psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences)
> associated with at least 1 of the 3 following consequences:
> *unequivocal and observable change in functioning uncharacteristic of the persons usual behavior
> *marked impairment in social or occupational functioning observable by others
> *requiring hospitalization or outpatient treatment
>
> -no minimum duration of symptoms is required
>
> -no exclusion criteria
>
> -bipolar-specifier criteria include all cases meeting DSM-IV criteria for bipolar 1 and 2 disorders as well as additional cases excluded by DSM-IV exclusionary criteria (eg, symptoms occuring during antidepressant treatment)
>
>
> b2c.
>Hi B2C, thank you so much for posting. I just want to know whether this is the criteria you described for a mixed episode? Do you also know why the other descriptions are inaccurate?
icu_baby
Posted by B2chica on November 9, 2011, at 9:19:38
In reply to Re: Bipolarity-Specifier Criteria......NEW, posted by icu_baby on November 3, 2011, at 23:43:22
as of right now i think this includes mixed episode.
i don't know if id say inaccurate as much as i would say incomplete. but for two reasons #1 i feel they don't include all they should, and also include things that could dispel a persons episodes thus making the assumption on an individual then getting wrong medication. and also because that is what the article was stating.
From my personal experience i can tell you how my 'mixed' episode presents itself, however i will include all my symptoms but not all symptoms occur at every episode.
mine normally start with some mild (very mild) euphoria some would consider it to just be high functioning, however that quickly turns to anger, sometimes rage, or severe agitation then it directs inward. becoming physical, almost shaking like inside.
when this is inward i have racing thoughts so badly that i cannot concentrate on one single item, its like my head is filled with words and descriptions but they are bottlenecked and cannot come out, or at least not in the right order. i talk fast but jump topics like their hurdles.
i have literal temper tantrums where for a little while i lash out at everyone around me, hit a wall or throw something.
Very agitated about everyone and every thing.
Often with either insomnia or hypersomnia
i used to cut or bruise myself.
Then sometimes it would get ugly, i could hear an inner voice echoing my thoughts, or what i'm doing, sometimes telling me to do harming things, these also play out as dares to myself, or obsessive thoughts on the activity, also to do dangerous things (example jump of into large rocks), road rage, walk across a busy street at a leisurely pace. and once i was tired of fighting voices that told me i had to cut off my left hand. i tried it and luckily the blood ended me 'snapping out of it' and wound up at the ER that night.
i can hear and see things but they are not TRUE hallucinations (at least the way they've been explained to me). they are more illusions as they are hidden within other sounds.MIxed Episodes have also been explained to me as having both manic and depressive episode?? but to me that sounds more like rapid cycling? and whats the difference? i don't rightly know.
***************************************
so to me i think they leave a lot out of whats there right now. or have things in that i wish they didn't.
for example, i like that they are now changing to 'no min duration of symptoms. As even though mine normally last a period of time, there have been times that mine only lasted 3-5 days. i've even had a 2 day episode and by rights that excluded me in the past.and as of now i would fit quite well. and since that's what my pdoc and T had suspected, it makes things more clear and meds action more clear.
i also like that they added that its an 'observable change in behavior' as sometimes i think I'm having episode but others don't really see a change in me.
Posted by Phillipa on November 9, 2011, at 18:47:15
In reply to Re: Bipolarity-Specifier Criteria......NEW » icu_baby, posted by B2chica on November 9, 2011, at 9:19:38
B2chica great writing. And it's easy to understand. Are you feeling better now? Phillipa
This is the end of the thread.
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