Psychotherapy High Wycombe Psychotherapy High Wycombe - Last updated 24 April 2024

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DSM-IV and DSM-IV-TR:

Mixed Episode

When an individual experiences a discrete period during which characteristics of both major depressive and manic episodes are evident, it is classified as a mixed episode. The individual may be diagnosed with one of the bipolar disorders.

Criteria for Mixed Episode

A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication, or other treatment) or a general medical condition (e.g. hyperthyroidism).
Note: Mixed-like episodes that are clearly caused by somatic anti-depressant treatment (e.g. medication, electro-convulsive therapy, light-therapy) should not count toward a diagnosis of Bipolar I Disorder.

Criteria for Severity/Psychotic/Remission Specifiers for current (or most recent) Mixed Episode

Note: Code in fifth digit. Can be applied to a Mixed Episode in Bipolar I Disorder only if it is the most recent type of mood episode.

.x1--Mild: No more than minimum symptom criteria are met for both a Manic Episode and a Major Depressive Episode.

.x2--Moderate: Symptoms or functional impairment between "mild" and "severe."

.x3--Severe Without Psychotic Features: Almost continual supervision required to prevent physical harm to self or others.

.x4--Severe With Psychotic Features: Delusions or hallucinations. If possible, specify whether the psychotic features are mood-congruent or mood-incongruent:

Mood-Congruent Psychotic Features: Delusions or hallucinations whose content is entirely consistent with the typical manic or depressive themes.
Mood-Incongruent Psychotic Features: Delusions or hallucinations whose content does not involve typical manic or depressive themes. Included are such symptoms as persecutory delusions (not directly related to grandiose or depressive themes), thought insertion, and delusions of being controlled.

.x5--In Partial Remission: Symptoms of a Mixed Episode are present but full criteria are not met, or there is a period without any significant symptoms of a Mixed Episode lasting less than 2 months following the end of the Mixed Episode.

.x6--In Full Remission: During the past 2 months, no significant signs or symptoms of the disturbance were present.

.x0--Unspecified.

Based on the Diagnostic & Statistical Manual of Mental Disorders, 4th edition APA

The online Diagnostic & Statistical Manual of Mental Disorders lists most of the major psychological disorders and illnesses and lists the criteria that must be fulfilled in order for a diagnosis to be made. This resource is not a substitute for proper professional psychiatric diagnosis.