Mixed affective state

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Mixed affective state
Other names	Mixed affective state, mixed episode, mixed-manic episode, dysphoric mania
"Melancholy passing into mania", illustration portraying the "inbetween" like state that many people in a mixed episode might feel
Specialty	Psychiatry
Symptoms	Depressed mood, racing thoughts, agitation, anxiety, irritability/aggression, emotional lability, suicidal ideation[1]
Differential diagnosis	Anxiety, borderline personality disorder, ADHD

A mixed affective state, formerly known as a mixed-manic or mixed episode, has been defined as a state wherein features and symptoms unique to both depression and (hypo)mania, including episodes of anguish, despair, self doubt, rage, excessive impulsivity and suicidal ideation, sensory overload, racing thoughts, heightened irritability, decreased "need" for sleep and other symptoms of depressive and manic states occur either simultaneously or in very short succession.

Previously, the diagnostic criteria for both a manic and depressive episode had to be met in a consistent and sustained fashion, with symptoms enduring for at least a week (or any duration if psychiatric hospitalization was required), thereby restricting the official acknowledgement of mixed affective states to only a minority of patients with bipolar I disorder.

In current DSM-5 nomenclature, however, a "mixed episode" no longer stands as an episode of illness unto itself; rather, the symptomology specifier "with mixed features" can be applied to any major affective episode (manic, hypomanic, or depressive), meaning that they are now officially also recognized in patients with bipolar II disorder and, by convention, major depressive disorder. A depressive mixed state in a patient, however, even in the absence of discrete periods of mania or hypomania, effectively rules out unipolar depression.