The formal diagnosis of a mixed episode rests on these symptoms, which can be evaluated by psychiatrists and other mental health professionals.
Symptoms of Major Depressive, Manic, Hypomanic and Mixed Episodes
Because the lists of symptoms for major depressive, manic, hypomanic and mixed episodes play closely interrelated roles in the diagnosis of mood disorders, all are included here separately. The following diagnostic criteria are reproduced verbatim from page 365 of the DSM-IV TR (where ‘IV TR’ indicates fourth edition, text revision).
Criteria for Mixed Episode
A. The criteria are met for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hypothyroidism).
Note: Mixed-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.
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