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Treatment of Mixed Features in Bipolar Disorder: an Updated View.
Curr Psychiatry Rep. 2020 Feb 06; 22(3):15.CP

Abstract

PURPOSE OF REVIEW

Mixed presentations in bipolar disorder have long posed clinical and nosological challenges. The DSM-5 mixed features specifier was developed to provide a more flexible and clinically relevant definition of mixed presentations compared with narrowly defined DSM-IV mixed episodes. However, there is little guidance on treating such presentations. Here, we summarize the evidence for biological treatments of DSM-5 and similarly defined mixed features (MFs).

RECENT FINDINGS

The literature on treating MFs is almost exclusively based on post hoc analyses. Within this limited evidence base is preliminary positive data for aripiprazole, asenapine, cariprazine, olanzapine, risperidone, and ziprasidone in treating acute mania with MFs, and cariprazine, lurasidone, olanzapine, and ziprasidone for depressive symptoms in depression with MFs. Divalproex may also be efficacious for acute mania with MFs. The few extant maintenance studies suggest that divalproex and olanzapine may have long-term efficacy in those with index MFs or for the prevention of MFs, respectively. The existing evidence suggests that clinicians consider atypical antipsychotics and divalproex for treating acute mixed presentations. However, adequately powered treatment trials-and studies of maintenance and neurostimulation therapies-are needed. Additionally, data-driven techniques to identify relevant symptom clusters may help improve our conceptualization of mixed presentations.

Authors+Show Affiliations

Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada. l.yatham@ubc.ca.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32025903

Citation

Chakrabarty, Trisha, et al. "Treatment of Mixed Features in Bipolar Disorder: an Updated View." Current Psychiatry Reports, vol. 22, no. 3, 2020, p. 15.
Chakrabarty T, Keramatian K, Yatham LN. Treatment of Mixed Features in Bipolar Disorder: an Updated View. Curr Psychiatry Rep. 2020;22(3):15.
Chakrabarty, T., Keramatian, K., & Yatham, L. N. (2020). Treatment of Mixed Features in Bipolar Disorder: an Updated View. Current Psychiatry Reports, 22(3), 15. https://doi.org/10.1007/s11920-020-1137-6
Chakrabarty T, Keramatian K, Yatham LN. Treatment of Mixed Features in Bipolar Disorder: an Updated View. Curr Psychiatry Rep. 2020 Feb 6;22(3):15. PubMed PMID: 32025903.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of Mixed Features in Bipolar Disorder: an Updated View. AU - Chakrabarty,Trisha, AU - Keramatian,Kamyar, AU - Yatham,Lakshmi N, Y1 - 2020/02/06/ PY - 2020/2/7/entrez PY - 2020/2/7/pubmed PY - 2020/2/7/medline KW - Antipsychotic KW - Bipolar disorder KW - DSM-5 KW - Mixed episodes KW - Mixed features KW - Mood stabilizer SP - 15 EP - 15 JF - Current psychiatry reports JO - Curr Psychiatry Rep VL - 22 IS - 3 N2 - PURPOSE OF REVIEW: Mixed presentations in bipolar disorder have long posed clinical and nosological challenges. The DSM-5 mixed features specifier was developed to provide a more flexible and clinically relevant definition of mixed presentations compared with narrowly defined DSM-IV mixed episodes. However, there is little guidance on treating such presentations. Here, we summarize the evidence for biological treatments of DSM-5 and similarly defined mixed features (MFs). RECENT FINDINGS: The literature on treating MFs is almost exclusively based on post hoc analyses. Within this limited evidence base is preliminary positive data for aripiprazole, asenapine, cariprazine, olanzapine, risperidone, and ziprasidone in treating acute mania with MFs, and cariprazine, lurasidone, olanzapine, and ziprasidone for depressive symptoms in depression with MFs. Divalproex may also be efficacious for acute mania with MFs. The few extant maintenance studies suggest that divalproex and olanzapine may have long-term efficacy in those with index MFs or for the prevention of MFs, respectively. The existing evidence suggests that clinicians consider atypical antipsychotics and divalproex for treating acute mixed presentations. However, adequately powered treatment trials-and studies of maintenance and neurostimulation therapies-are needed. Additionally, data-driven techniques to identify relevant symptom clusters may help improve our conceptualization of mixed presentations. SN - 1535-1645 UR - https://www.unboundmedicine.com/medline/citation/32025903/Treatment_of_Mixed_Features_in_Bipolar_Disorder:_an_Updated_View L2 - https://dx.doi.org/10.1007/s11920-020-1137-6 DB - PRIME DP - Unbound Medicine ER -
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