A comparative study of clinical correlates of bipolar mixed state with bipolar manic and bipolar depressed state in a general hospital psychiatry setting
Background: Mixed states pose diagnostic dilemmas and raise the question of their existence as separate diagnostic category. There are few Indian studies on mixed affective disorder particularly with respect to the diagnosis and clinical comparison of patients with mixed state and other subtypes of bipolar disorder.
Aim: To elucidate course and clinical correlates in patients with bipolar mixed state and compare them to patients with bipolar depression and mania.
Methods: A total of 70 inpatients of psychiatric ward meeting the inclusion criteria were followed up from the day of admission till discharge and assessed on Hamilton Depression Rating Scale (HDRS), Young’s Mania Rating Scale (YMRS), Positive and Negative Symptom scale for Schizophrenia (PANSS), Beck Scale for Suicidal Ideation, Clinical Global Impression Schedule (CGI) and Presumptive Stress Life Event Scale.
Results: Our study found mixed group to be characterized by female preponderance, higher suicidal intent, expression being the first episode, severe illness as rated on CGI-S, increased frequency of psychotic symptoms and mean number of manic and depressive symptoms midway between the other two groups.
Conclusion: The mixed affective state although has clinical correlates that differ from bipolar mania and depression, behaves as interforms of mania and depression.
Keyword: Bipolar mania, Bipolar mixed state, Bipolar depression, Course variables, Clinical profile