American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994.
Swann, AC, Lafer, B, Perugi, G, et al. Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis. Am J Psychiatry. 2013; 170(1): 31–42.
Castle, DJ. Bipolar mixed states: still mixed up?
Curr Opin Psychiatry. 2014; 27(1): 38–42.
Benvenuti, A, Miniati, M, Callari, A, Giorgi Mariani, M, Mauri, M, Dell’Osso, L. Mood spectrum model: evidence reconsidered in the light of DSM-5. World J Psychiatry. 2015; 5(1): 126–137.
Kessing, LV. The prevalence of mixed episodes during the course of illness in bipolar disorder. Acta Psychiatr Scand. 2008; 117(3): 216–224.
McIntyre, RS, Soczynska, JK, Cha, DS, et al. 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. J Affect Disord. 2015; 172: 259–264.
Verdolini, N, Agius, M, Ferranti, L, Moretti, P, Piselli, M, Quartesan, R. The state of the art of the DSM-5 “with mixed features” specifier. The Scientific World Journal. 2015; 2015: 757258.
Shim, IH, Woo, YS, Jun, TY, Bahk, WM. Mixed-state bipolar I and II depression: time to remission and clinical characteristics. J Affect Disord. 2014; 152–154: 340–346.
Undurraga, J, Baldessarini, RJ, Valenti, M, Pacchiarotti, I, Vieta, E. Suicidal risk factors in bipolar I and II disorder patients. J Clin Psychiatry. 2012; 73(6): 778–782.
Shim, IH, Woo, YS, Bahk, WM. Prevalence rates and clinical implications of bipolar disorder “with mixed features” as defined by DSM-5. J Affect Disord. 2015; 173: 120–125.
Popovic, D, Vieta, E, Azorin, JM, et al. Suicide attempts in major depressive episode: evidence from the BRIDGE-II-Mix study. Bipolar Disord. 2015; 17(7): 795–803.
Benazzi, F, Berk, M, Frye, MA, Wang, W, Barraco, A, Tohen, M. Olanzapine/fluoxetine combination for the treatment of mixed depression in bipolar I disorder: a post hoc analysis. J Clin Psychiatry. 2009; 70(10): 1424–1431.
Patkar, A, Gilmer, W, Pae, CU, et al. A 6 week randomized double-blind placebo-controlled trial of ziprasidone for the acute depressive mixed state. PLoS One. 2012; 7(4): e34757.
Pae, CU, Patkar, AA, Gilmer, W, Holtzman, N, Thommi, SB, Ghaemi, SN. Predictors of response to ziprasidone: results from a 6-week randomized double-blind, placebo-controlled trial for acute depressive mixed state. Pharmacopsychiatry. 2012; 45(4): 152–155.
Tohen, M, Kanba, S, McIntyre, RS, Fujikoshi, S, Katagiri, H. Efficacy of olanzapine monotherapy in the treatment of bipolar depression with mixed features. J Affect Disord. 2014; 164: 57–62.
McIntyre, RS, Cucchiaro, J, Pikalov, A, Kroger, H, Loebel, A. Lurasidone in the treatment of bipolar depression with mixed (subsyndromal hypomanic) features: post hoc analysis of a randomized placebo-controlled trial. J Clin Psychiatry. 2015; 76(4): 398–405.
McIntyre, RS, Tohen, M, Berk, M, Zhao, J, Weiller, E. DSM-5 mixed specifier for manic episodes: evaluating the effect of depressive features on severity and treatment outcome using asenapine clinical trial data. J Affect Disord. 2013; 150(2): 378–383.
Tohen, M, McIntyre, RS, Kanba, S, Fujikoshi, S, Katagiri, H. Efficacy of olanzapine in the treatment of bipolar mania with mixed features defined by DSM-5. J Affect Disord. 2014; 168: 136–141.
Suppes, T, Ketter, TA, Gwizdowski, IS, et al. First controlled treatment trial of bipolar II hypomania with mixed symptoms: quetiapine versus placebo. J Affect Disord. 2013; 150(1): 37–43.
Perlis, RH, Cusin, C, Fava, M. Proposed DSM-5 mixed features are associated with greater likelihood of remission in out-patients with major depressive disorder. Psychol Med. 2014; 44(7): 1361–1367.
Suppes, T, Silva, R, Cucchiaro, J, et al. Lurasidone for the treatment of major depressive disorder with mixed features: a randomized, double-blind, placebo-controlled study. Am J Psychiatry. 2016; 173(4): 400–407.
Fagiolini, A, Coluccia, A, Maina, G, et al. Diagnosis, epidemiology and management of mixed states in bipolar disorder. CNS Drugs. 2015; 29(9): 725–740.
Fountoulakis, KN, Kontis, D, Gonda, X, Siamouli, M, Yatham, LN. Treatment of mixed bipolar states. Int J Neuropsychopharmacol. 2012; 15(7): 1015–1026.
McIntyre, RS, Yoon, J. Efficacy of antimanic treatments in mixed states. Bipolar Disord. 2012; 14(Suppl 2): 22–36.
Muralidharan, K, Ali, M, Silveira, LE, et al. Efficacy of second generation antipsychotics in treating acute mixed episodes in bipolar disorder: a meta-analysis of placebo-controlled trials. J Affect Disord. 2013; 150(2): 408–414.
McElroy, SL, Martens, BE, Creech, RS, et al. Randomized, double-blind, placebo-controlled study of divalproex extended release loading monotherapy in ambulatory bipolar spectrum disorder patients with moderate-to-severe hypomania or mild mania. J Clin Psychiatry. 2010; 71(5): 557–565.