Bipolar bozukluk, karma dönemlerin tani ve tedavisindeki gelişmeler

Bipolar disorder is a common, severe, recurrent, and life-threatening illness. Mixed states are a common manifestation of this illness and often respond poorly to treatment. Current diagnostic criteria, based on phenomenology, are limited, resulting in both the under- and misdiagnosis of mixed states, and mismanagement of the illness. This can lead to worsening of the illness course. Definition, diagnosis, and treatment of mixed states are reviewed here, with emphasis on the restrictive nature of the DSM-IV definition. Treatment strategies that focus on regulating mood will have the best chance of achieving mood stability. Such approaches are optimizing the use of mood stabilizers and antipsychotics either as monotherapy or in combination, and avoidance of the use of agents that may cause worsening of mood instability, such as antidepressants either as monotherapy or in combination with a mood stabilizer or an antipsychotic.