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Mieszane stany depresyjne: symptomatologia, rozpowszechnienie i zasady leczenia

Author(s): Wiktor Dróżdż

Journal: Neuropsychiatria i Neuropsychologia
ISSN 1896-6764

Volume: 3;
Issue: 2;
Start page: 85;
Date: 2008;
Original page

Keywords: affective disorders | diagnostic criteria | mixed states | treatment

Current diagnostic systems (DSM-IV-TR and ICD-10)do not include depressive mixed state (DMS) asa separate category. However, both historicaldescriptions and data from recent research clearlyindicate that cooccurrence of (hypo)maniacal anddepressive symptoms is standard in clinical picture ofaffective disorders. Most frequently employed criterionfor DMS is the presence of at least three symptoms of(hypo)mania for 7 days during a major depressiveepisode. Not only formal diagnostic criteria for DMSare lacking but also psychometric assessment tools weredesigned around the features of “classical” depression.The other obstacles to recognize DMS could be lack ofinsight into the (hypo)maniacal symptoms in patientsand cognitive dysfunctions present during an episode.On the other hand, newly created instrument, theBipolar Depression Rating Scale, may assist clinicalevaluation of DMS. Despite predominating depressivesymptomatology, the principles of treatment of DMSsuggest avoidance of antidepressant monotherapy infavor of mood stabilizer’s administration. Actually DMSmay emerge as a complication of antidepressantmonotherapy in some bipolar patients. Importantconsequences of both spontaneous and drug-inducedDMS could be the roughening of affectivesymptomatology and the increase of suicidality.Thorough appraisal of symptoms seen in patients withaffective disorders for indicators of DMS could havecritical consequences for functional outcomes.
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