Psychiatr. pro Praxi, 2009; 10(5): 209-215

Mixed episode in bipolar affective disorder and its treatment

MUDr. Klára Látalová Ph.D³, doc. MUDr. Ján Praško CSc^1,3,2,4, MUDr. Radim Kubínek³, MUDr. Erik Herman^5,7,6, MUDr. Pavel Doubek⁵

¹ Psychiatrické centrum Praha, 3. LF UK, Praha

² Centrum neuropsychiatrických studií, Praha

³ Psychiatrická klinika FN a LF UP, Olomouc

⁴ 3. LF UK, Praha

⁵ Psychiatrická klinika 1. LF UK a VFN Praha

⁶ Neurologické oddělení, neuropsychiatrické a epileptologické centrum, Nemocnice Na Františku s poliklinikou, Praha

⁷ Psychiatrická ambulance, Praha

Mixed epizodes are characterized by the mixture of depressive and manic symptoms. This state experience almost half of bipolar patiens.

Manic symptoms in mixed states usually are dysphoric, with irritability, anxiety, or unpleasant activation. Such states can be difficult to

distinguish from ultradian cycling, in which moods change so rapidly that they seem to blend into each other. Mixed states of bipolarity

represent a generally more difficult phase of the illness to treat with any medication. Lithium has long been considered as less than ideal

in the management of mixed states in bipolar disorder. Valproate and carbamazepine have strong evidence for effectiveness in mixed

mania. Some second generation antipsychotics (olanzapine, aripiprazole, ziprasidone, risperidone) have evidence of effectiveness in

acute treatment and some (olanzapin, quetiapin) in profylaxis. Lamotrigine has been established as ineffective in mixed epizodes.

Keywords: mixed states, bipolar affective disorder, antipsychotic agents, antidepressants, mood stabilizers.

Published: November 1, 2009  Show citation