Clinical picture and etiologic models of mixed states

Although conceptualized as polar opposites, manic and depressive symptoms o ften co-occur in bipolar disorder. This article explores the clinical chara cteristics, prevalence, biologic features, and response to treatments of mi xed states. Issues of diagnosis and cause are considered. The course is oft en protracted beyond acute episodes, psychotic symptoms are common, and sui cide is a major risk. Bipolar mixed states are over represented in women. M ixed states respond poorly to lithium salts; mood stabilizers, particularly divalproex, are the mainstay of modern treatment. Electroconvulsive therap y is also effective, and can be used in severe cases.