BERLIN – “Bipolar disorder mixed states – focus on mania with depressive features” was the subject of the presentation by Professor Allan Young, Centre for Affective Disorders, Institute of Psychiatry, King’s College London, at the 7th Biennial Congress of The International Society for Affective Disorders (ISAD), held in Berlin at the end of April. Professor Young has been interviewed by Marco Mozzoni.

First of all: Bipolar disorder (BD) is a complex condition. A recent survey shows that 64% of patients reported feeling depressed when experiencing a manic episode; 72% of patients who experienced mania with depressive symptoms suffered from anxiety, irritability and agitation. “Mixed states” represent a severe presentation of bipolar disorder, with longer hospital stays, more episodes and hospitalization, greater impairment, higher risk of suicide.

Professor Allan Young holds the Chair of Mood Disorders at King’s College London where he is also Director of the Centre for Affective Disorders within the Department of Psychological Medicine in the Institute of Psychiatry. Professor Young’s research interests focus on the cause and treatments for severe psychiatric illnesses, particularly mood disorders. He has published over 300 peer-reviewed publications and a number of books about psychopharmacology and affective disorders.

Professor Young, you say “Mixed states represent a severe presentation of bipolar disorder”: which one (Manic with mixed features, Depressive with mixed features) is the worst and why?

Mania with depression is probably the worst as the outcome of the illness is poorer and suicide risk is high.

Prevalence of suicidality among patients with “mixed mania” (Mania with depressive symptoms) is near to 60% of patients vs. near to 0% in “pure mania” patients. Why? Are depressive symptoms a risk factor, or manic symptoms a protective factor for suicidality in BD patients?

The combination of increased activity and low mood is the key to understanding why mania with depressive symptoms is so risky.

Will the new DSM-5 “with mixed features” specifier for hypomanic and manic episodes help clinicians in diagnosing and treating BD patients? How?

The new DSM-5 will allow greater subtly in diagnosis which should more accurately guide treatment.

Your study shows that “The incidence of suicidality was greater in patients with ≥3 depressive symptoms compared with patients with 0–2 depressive symptoms”. Have you investigated which “one” of the symptoms is crucial?

It is likely that it is depressive symptoms per se rather than any particular one.  However, impulsivity and increased energy are particularly important.

Is BD a treatable condition or a chronic disease?

Both.

Do you think BD is underdiagnosed?

Yes BD is underdiagnosed.

Is there any screening opportunity?

Screening tools are available but under used.

Is BD preventable?

No, but relapse and recurrence are and the fewer episodes the less damage to the person.

Image credits: Alexandr23, Emotionally depressed young male is sitting on the floor with his hands on the head. Shutterstock.com