Hypomanic symptoms in mixed depression – is DSM-5 wrong? Evidence from the BRIDGE-II-MIX study

Abstract

Introduction DSM-5 criteria for the mixed features specifier exclude symptoms, such as psychomotor agitation, irritability and mood lability. Objectives The goal of the BRIDGE-MIX study was to provide an estimate of the frequency of mixed states (MXS) in depressed patients according to different definitions and to compare their clinical validity. Aims The aim of this sub-analysis is to examine the importance of distinct hypomanic symptoms in mixed depression, including those excluded from DSM-5. Methods A total of 2811 subjects were enrolled in this multicentric cross-sectional study. Psychiatric symptoms, socio-demographic and clinical variables representing risk factors for bipolar disorder (BD) were collected. Multiple comparisons analysis was performed using a Bonferroni-corrected threshold and stepwise-backward logistic regression. Results Two hundred and twelve patients fulfilled DSM-5 criteria for MXS. The most common symptoms in this subset and in the total sample are shown in Table 1 (Tables are not available for this abstract). Logistic regression demonstrated specific associations of psychomotor agitation (Wald 5.092, P =0.024), impulsivity (Wald 28.47, P P P Conclusions The DSM-5 definition of MXS excludes overlapping mood criteria, such as psychomotor agitation, irritability and mood lability, among the most frequent features of mixed depression in our sample and in literature. The results of this study highlight the impact of the excluded symptoms on MXS diagnosis. Although these symptoms may be non-specific, their exclusion from DSM-5 may not be justified, in the absence of evidence that the remaining criteria are sufficiently sensitive to identify MXS.