Mixed Episodes in Bipolar Disorders - Changes in DSM-5 and Treatment Recommendations

Mixed episodes in the course of affective disorders are challenging for any psychiatrist, because they are often characterized by a complicated and difficult treatment course (e.g. higher suicide rates) and a worse treatment outcome. In DSM-5, one of the main changes is that the diagnosis of a mixed episode was disestablished and replaced with affective episodes with so called "mixed features". This alteration markedly reduces the diagnostic threshold. The available literature on pharmacological treatment of mixed episodes is not sufficient; however, treatment with atypical antipsychotics, especially olanzapine and aripiprazole and the mood stabilizers valproate and carmabazepine has proved to be beneficial.