Mania mixed affective state

Zubieta JK, DemitrackMA. Possible bupropion precipitation of mania and a mixed affective state, J Clin Psychopharmacol (1991) 11,327-8. 

Consider a mixed affective state fTable 54.11 if depression or mania don t quite fit, due to a mix of mood, drive and behavioural problems, e.g. depression with over-activity or sexual disinhibition. 

Problems with mood are often called affective disorders. Depression and mania are often seen as opposite ends of an affective or mood spectrum. Classically, mania and depression are poles apart, thus generating the terms unipolar depression, in which patients just experience the down or depressed pole and bipolar disorder, in which patients at different times experience either the up (manic) pole or the down (depressed) pole. In practice, however, depression and mania may occur simultaneously, which is called a mixed mood state. Mania may also occur in lesser degrees, known as hypomania, or may switch so fast between mania and depression that it is called rapid cycling. ... 

Beginning with Kraepelin s (1921) systematic classification of dysphoric mania, considerable attention has been paid to mixed states of bipolar disorder. Kraepelin s model was based on variable symptom patterns expressed in three areas, mood, thought, and motor activity. Once considered to be uncommon, current estimates suggest that the prevalence rate for dysphoric, or mixed mania, is approximately 30 percent (McElroy et al. 1992). Debate continues regarding the status of mixed mania as a distinct affective state versus a form, or stage, of typical mania. However, there is convincing evidence to support the opinion that mixed episodes can be more severe, chronic, and difficult to treat than pure manic or depressive episodes (Clothier,... 

In the bipolar affective disorders (BPADs), periods of normal mood are interspersed with episodes of mania, hypomania, mixed states, or depression. BPAD differs from MDD in that there is a bidirectional natnre to the mood swings and, for many patients, the rate of cycling is more rapid in BPAD than MDD. The phases of BPAD inclnde mania, hypomania, and depression, though mixed states, the simultaneous presentation of symptoms of both mania and depression, are common. 

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