*Sciencey blog hopefully but just a deeper look into mixed episodes. This is a collection of research more than my own words so the likelihood I own any of it is slim*
Bipolar Disorder I. Bipolar disorder I is characterized by at least one manic episode or mixed episode (symptoms of both mania and depression occurring simultaneously), and one or more depressive episodes, that lasts for at least 7 days. In most cases, manic episodes precede or follow depressive episodes in a regular pattern. Episodes are more acute and severe than in the other two categories.
Without treatment, patients average four episodes of dysregulated mood each year. With mania, either euphoria or irritability may mark the phase. In addition, there are significant negative effects (such as sexual recklessness, excessive and impulsive shopping, and sudden traveling) on a patient’s social life, performance at work, or both. Untreated mania lasts at least a week, and it can last for months. Typically, depressive episodes tend to last 6 – 12 months, if left untreated.
We establish here that mixed episode is a bipolar 1 trait.
Just what is Bipolar Mixed States?
In the context of mental illness, a Mixed States is a condition during which symptoms of mania and depression occur simultaneously (e.g., agitation, anxiety, fatigue, guilt, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, pressured speech and rage). Typical examples include tearfulness during a manic episode or racing thoughts during a depressive episode. Mixed States can be the most dangerous period of mood disorders, during which substance abuse, panic disorder, suicide attempts, and other complications increase greatly.
But there are different types of mixed episodes:
A dysphoric mania consists of a manic episode with depressive symptoms. Increased energy and some form of anger, from irritability to full blown rage, are the most common symptoms (MMDT). Symptoms may also include auditory hallucinations, confusion, insomnia, persecutory delusions, racing thoughts, restlessness, and suicidal ideation. Alcohol, drug abuse, and some antidepressant drugs may trigger dysphoric mania in susceptible individuals.
An agitated depression is a “major depressive [episode] with superimposed hypomanic symptoms” (Benazzi, 2000). Mixed episodes in which major depression is the primary state, concurrent with atypical manic features were described in two studies (Benazzi & Akiskal, 2001; Perugi et al., 2001). A study by Goodwin and Ghaemi (2003) reported manic symptoms in two-thirds of patients with agitated depression, which they suggest calling “mixed-state agitated depression”.
Most researchers find that the cause of Bipolar Disorder is related to Genetic factors which may contribute substantially to the likelihood of developing bipolar disorder. And environmental factors are also implicated. Scientists also believe that bipolar disorder may be caused when chemicals in the brain are out of balance.
Evidence suggests that environmental factors play a significant role in the development and course of Bipolar Disorder, and that individual psychosocial variables may interact with genetic dispositions.
There is fairly consistent evidence from prospective studies that recent life events and interpersonal relationships contribute to the likelihood of onsets and recurrences of Bipolar Mood Episodes, as they do for onsets and recurrences of unipolar depression.
There have been repeated findings that between a third and a half of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood, which is associated on average with earlier onset, a worse course, and more co-occurring disorders such as Post Traumatic Stress Disorder (PTSD).
The total number of reported stressful events in childhood is higher in those with an adult diagnosis of Bipolar Spectrum disorder compared to those without, particularly events stemming from a harsh environment rather than from the child’s own behavior. Early experiences of adversity and conflict are likely to make subsequent developmental challenges in adolescence more difficult, and are likely a potentiating factor in those at risk of developing bipolar disorder.
Beginning to treat depression and mania will also treat the mixed episodes which is why mood stablizers are sworn by for getting rid of them.