Mixed Episodes Research Articles

Homocysteine, chronotype and clinical course in bipolar disorder patients

Purpose: Higher homocysteine (HHcy) levels have been detected in bipolar disorder (BD) patients, and BD patients show circadian rhythm disorders even during remission. Here, we determined the homocysteine (Hcy) levels and chronotype of patients with BD during remission and investigated whether this was related to the clinical course of the disease. Materials and methods: In total, 80 BD outpatients were included. Clinical evaluation was conducted using the Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Pittsburgh Sleep Quality Index (PSQI) and the Morningness–Eveningness Questionnaire (MEQ). Hcy, folic acid, vitamin B12 levels and protein consumption the day before clinical evaluation were measured.Results and conclusions: HHcy was found in 11 patients (8.8%), most of whom were males (n = 8, 72.7%). During the course of BD, patients with HHcy had significantly more mixed episodes than patients without HHcy (p = .007, z = −2696). In addition, patients with HHcy had significantly lower MEQ scores than patients without HHcy (p = .04, t = 2018). There was no significant difference in chronotype between patients with and without HHcy. The HHcy group had significantly lower levels of vitamin B12 (p = .003, t = 2870). There were no statistically significant differences in daily protein intake and folic acid levels between HHcy and non-HHcy groups. Our study showed a significant relationship between the number of mixed episodes and HHcy. In terms of potential confounds, patients who abused alcohol were excluded, but alcohol consumption was not evaluated. This result should be considered in BD and should be evaluated in larger samples of BD patients.

AGE AND GENDER FEATURES OF DEPRESSIVE AND ANXIETY SYMPTOMATICS OF DEPRESSIVE DISORDERS

The aim: of the study is to study the features of the clinical phenomenology of depressive disorders at the present stage, taking into account gender and age factors. Materials and methods: Clinically examined 107 men and 138 women with bipolar affective disorder (current episode of depression), depressive episode and recurrent depressive disorder using HDRS, HARS, BDI, C. Spilberger's Scale of Reactive and Personality Anxiety. Results: In all patients showed an increase in the severity of depression and anxiety with age, but in women the greatest differences were found between the middle and older age groups, and in men when comparing young and middle age groups. In young patients the level of agitated depression is higher for men, and women showed the higher overall level of anxiety, somatic anxiety, undifferentiated depression, reactive and personality anxiety. In patients aged 30-44, men have a significantly higher overall score of HARS depression, the level of adynamic, agitated and undifferentiated depression, the level of depression on BDI. In the older age group, the levels of depression in men and women are not significantly different, and the levels of mental anxiety and personality anxiety in women are significantly higher. Conclusions: The general tendency consisting in increasing the severity of depression with age, and more pronounced indicators of depression in men, and anxiety in women. In men, the greatest increase in the severity of depression occurs before the age of 44 years, and in women after 45 years.

Huntington’s disease presenting as mixed state episode

Huntington’s disease presenting as mixed state episode

CBT of Anxiety and Depressive Disorders in Foreign Medical Students

The article discusses the use of cognitive-behavioral therapy in foreign medical students. It is well known thatdepression is the second most common disease in the world. The causes of depression are diverse. Different psychological schools see this disorder from different perspectives. Recently, we are increasingly seeing mixed anxiety-depressive episodes. Learning a medicine in a foreign language is an additional stress factor. Thus, the selected contingent needs a psychotherapeutic effect for adaptation. The article provides information on cognitive-behavioral therapy taking into account the gender characteristics of the contingent. In our opinion, cognitive-behavioral therapy is an optimal and short-term method of psychotherapeutic influence. Thus, a differentiated approach to the preparation of therapeutic programs based on the gender characteristics of anxiety-depressive disorder is effective and can be recommended for use with medical students.

Evidence-Based Treatment Targets, Selection, and Strategies for Acute Manic and Mixed Episodes of Bipolar I Disorder.

Too many patients receive incorrect treatment for bipolar disorder; prescribing seems to differ more by clinician than by patient characteristics. New treatment guidelines are available for the management of acute manic episodes and can help clinicians make treatment decisions tailored to their patients' individual symptom clusters and illness characteristics, leading to greater chances of lasting remission. However, many clinicians lack familiarity with these symptom targeting best practices. Therefore, clinicians need education on how to manage bipolar I disorder symptoms with evidence-based treatment options. In addition, as new treatment targets are identified, clinicians need education on psychopharmacologic and pharmacokinetic advances.

Features of changes in the cognitive sphere of patients with a primary episode of bipolar affective disorder

153 patients with primary episode of bipolar affective disorder were divided to three groups: with prevalence of depressive symptomatology (44 men and 75 women), with prevalence of manic symptoms (15 men and 8 women) and with simultaneous presence of depressive and manic symptomatology or with rapid or severe manic symptoms (6 men and 5 women) and were examined using the Rey–Osterrieth test. It was found that they had impaired cognitive functioning whose structure and severity were related to the clinical type of the primary episode. In patients with depressive variant revealed approximately equal deterioration of test performance across all assessment vectors, while reproduction (immediate and delayed) observed synchronous deterioration of indicators, with the degree of deterioration of characteristics between copying and immediate and retarded reproduction. In the manic variant the performance of test is significantly different from the depressive variant. Patients with a manic variant showed the lowest indicators in the presence of individual elements of the figure, accuracy and diligence. At the same time, indicators for most estimation vectors are unstable, varying with immediate and delayed reproduction without some systematicity. Such features reflect on the cognitive functions of the maniac state with its acceleration of the speed of thinking, its chaos, instability of attention, difficulties of concentration and inability to productive activity. In patients with mixed episode, the Ray–Osterrieth test scores reflect complex contradictory tendencies of changes in the affective area, related to the rapid phase change and the presence of opposite affective manifestations. Quantitative values of indicators in patients of this group has an intermediate position between indicators of patients with depressive and manic variants. Common disorders inherent in patients of all groups were distortion of the integrity and symmetry of the figure, contamination of the elements of the figure and the omission of minor details. The differences in the structure and severity of cognitive impairment between men and women are not statistically significant.

Cariprazine in the treatment of Bipolar Disorder: A systematic review and meta-analysis.

Cariprazine is a partial agonist at D2/D3 receptors that has been approved for the treatment of mania associated with bipolar disorder (BD). This meta-analysis aimed to assess the efficacy and tolerability of cariprazine in the treatment of BD. Randomized controlled trials investigating the efficacy of cariprazine in BD were included. Of the 391 studies yielded by search, 7 were included. The PRISMA protocol was followed and a set of analyses involving random-effects model with restricted maximum-likelihood estimator were used to synthesize effect sizes. Cariprazine was associated with a moderate and significant reduction of manic symptoms based on YMRS change scores (SMD: -0.52; 95%CI: -0.82 to -0.21; P=.018). Cariprazine resulted in significantly higher remission (OR: 2.05; 95%CI: 1.61-2.61; P=.006) and response rates (OR: 2.31; 95%CI: 1.35-3.95; P=.021) for manic and mixed episodes compared with placebo. Both cariprazine 1.5mg and 3mg doses were associated with small but significant reduction in depressive symptoms assessed with MADRS scores (SMD: -0.26, 95%CI: -0.49 to -0.02; P=.040) (SMD: -0.21, 95%CI: -0.41 to -0.01; P=.045), respectively. Cariprazine was significantly associated with the development of adverse effects but not with dropouts due to these adverse effects, when compared to placebo. Cariprazine appears to be safe and efficacious in the treatment of acute mania and mixed episodes associated with BD. Cariprazine at doses of 1.5-3mg/day is efficacious in acute bipolar depression but the effect sizes were smaller. Controlled studies evaluating its efficacy for prophylaxis are needed.

Caffeine prevents neurodegeneration and behavioral alterations in a mice model of agitated depression

Longitudinal and some experimental studies have showed the potential of caffeine to counteract some depressive behaviors and synaptic dysfunctions. In this study, we investigated the potential of caffeine in preventing behavioral outcomes, neurodegeneration and synaptic proteins alterations in a mice model of agitated depression by bilateral olfactory bulbectomy (OB). For this purpose, bulbectomized mice received caffeine (0.3 g/L and 1.0 g/L, drinking water), during the active cycle, for seven weeks (two before the surgery and throughout five weeks after OB). Caffeine prevented OB­induced hyperactivity and recognition memory impairment and rescue self care and motivational behavior. In the frontal cortex, bulbectomized mice presented increase in the adenosine A1 receptors (A1R) and GFAP, while adenosine A2A receptors (A2AR) increased in the hippocampus and striatum and SNAP-25 was decreased in frontal cortex and striatum. Caffeine increased A1R in the striatum of bulbectomized mice and in SHAM-water group caffeine increased A2AR in the striatum and decreased SNAP-25 in the frontal cortex. Astrogliosis observed in the polymorphic layer of the dentate gyrus of OB mice was prevented by caffeine as well as the neurodegeneration in the striatum and piriform cortex. Based on these behavioral and neurochemical evidences, caffeine confirms its efficacy in preventing neurodegeneration associated with memory impairment and may be considered as a promising therapeutic tool in the prophylaxis and/or treatment of depression.

Petrologic Insights into Rift Zone Magmatic Interactions from the 2011 Eruption of Kīlauea Volcano, Hawaiʻi

AbstractThe high frequency of historical eruptions at Kīlauea Volcano presents an exceptional opportunity to address fundamental questions related to the transport, storage, and interaction of magmas within rift zones. The Nāpau Crater area on Kīlauea’s East Rift Zone (ERZ) experienced nine fissure eruptions within 50 years (1961–2011). Most of the magma intruded during these frequent eruptions remained stored within the rift zone, creating a potential magma mixing depot within the ERZ. The superbly monitored and sampled 2011 eruption (Puʻu ʻŌʻō episode 59) presents an extraordinary opportunity to evaluate magma mixing processes within the ERZ. Whole-rock, glass, and olivine compositions were determined, not only for lava from the 2011 eruption, but also for a new suite of Nāpau Crater area samples from the 1963, 1965, 1968, 1983, and 1997 eruptions, as well as the previously undocumented 1922 eruption. Whole-rock XRF data revealed two geochemically distinct magma batches for episode 59: one less evolved (∼6·6 wt % MgO, 0·46 wt % K2O) than the other (∼6·2 wt % MgO, 0·58 wt % K2O). Episode 59 lava is remarkably aphyric (∼0·1 vol. % phenocrysts), making use of mineralogy to identify parent magma affinities problematic. Linear compositional trends of whole-rock major and trace elements, and reversely zoned olivine crystals indicate episode 59 lavas underwent magma mixing. Least squares regression calculations and plots of major and trace element data, were used to evaluate whether the episode 59 samples are products of mixing summit-derived magma with residual magma from previous Nāpau Crater area eruptions. The regression results and trace element ratios are inconsistent with previously proposed mixing scenarios, but they do support mixing between summit-derived magma and residual magma from the 1983 and 1997 Nāpau Crater area eruptions. These magmas were stored in physically and chemically distinct pods at depths of 1·6–3·0 km prior to mixing with new magma intruded from the summit to produce the episode 59 lava. One pod contained a fractionated equivalent of 1983 lava, and the other a hybrid of compositions similar to 1983 and 1997 lavas. The petrology of episode 59 lava demonstrates that magmas from two previous eruptions (1983 and 1997) were available to mix with magma intruded from the summit region. This study clarifies the pre-eruptive history of the mixed episode 59 lava, and elucidates the evolution of the volcano's magmatic system in a region of frequent eruptions.

Cognitive flexibility and problem-solving in patients with bipolar disorder

Introduction: This study focuses on the cognitive impairment in patients with bipolar disorder and also the distribution of cognitive flexibility and problem-solving by degree of education, chronicity, and episode of patient is in at the time of evaluation.Methods: This was a cross sectional descriptive study with purposive sampling method. The population was the Harmony in Diversity Group in Surabaya, Indonesia. Twenty-two patients agreed to be subjects and each of them finished the Wisconsin Card Sorting Test (WCST) to measure cognitive flexibility and the Tower of London (TOL) to measure problem-solving. Results: The WCST score are below normal for 90.9% of the patients. Higher cognitive flexibility is found in patients with bachelor’s degree and euthymic patients, while lower cognitive flexibility is found in patients in depression episode, manic episode, and mixed episode. No patients could finish the TOL within the minimum required steps. Better problem-solving is found in patients in manic episode and euthymic patients while lower problem-solving is found in mixed episode and depressive episode.Conclusion: The cognitive flexibility and problem-solving in patients with bipolar disorder are lower than the normal cut off. The type of episode and chronicity are contributing factors. Euthymic patients tend to have better cognitive flexibility and manic patients tend to have better problem-solving ability.

Efficacy and safety of cariprazine in the treatment of bipolar disorder

ABSTRACTIntroduction: Cariprazine, a D3-preferring, dopamine D2/D3 partial agonist, has efficacy in treating both acute phases of bipolar I disorder (BD-I). It has been approved by the FDA for treatment of acute manic, mixed and depressive episodes associated with BD-I.Areas covered: In this review, the authors discuss the unique pharmacological properties and clinical efficacy profile of cariprazine, and their relevance in the context of routine clinical decision-making for BD-I. For the purpose of this review, the authors searched for clinical trials in BD published in the PubMed, Web of Science, Embase and PsychInfo databases as well as for studies registered in the ClinicalTrials.gov database.Expert opinion: Based on evidence from RCTs in manic and mixed episodes, cariprazine in a dose-range of 3–12 mg is effective for treating acute mania and mixed states associated with BD-I. Importantly, evidence from placebo-controlled trials in bipolar depression suggests that cariprazine is also effective as a monotherapy in treating acute bipolar depression in doses of 1.5–3 mg/day. It is overall well tolerated; however, clinicians need to monitor patients for akathisia.

Thought and language disturbance in bipolar disorder quantified via process-oriented verbal fluency measures

Bipolar disorder (BD) is characterized by speech abnormalities, reflected by symptoms such as pressure of speech in mania and poverty of speech in depression. Here we aimed at investigating speech abnormalities in different episodes of BD, including mixed episodes, via process-oriented measures of verbal fluency performance – i.e., word and error count, semantic and phonological clustering measures, and number of switches–, and their relation to neurocognitive mechanisms and clinical symptoms. 93 patients with BD – i.e., 25 manic, 12 mixed manic, 19 mixed depression, 17 depressed, and 20 euthymic–and 31 healthy controls were administered three verbal fluency tasks – free, letter, semantic–and a clinical and neuropsychological assessment. Compared to depression and euthymia, switching and clustering abnormalities were found in manic and mixed states, mimicking symptoms like flight of ideas. Moreover, the neuropsychological results, as well as the fact that error count did not increase whereas phonological associations did, showed that impaired inhibition abilities and distractibility could not account for the results in patients with manic symptoms. Rather, semantic overactivation in patients with manic symptoms, including mixed depression, may compensate for trait-like deficient semantic retrieval/access found in euthymia.“For those who are manic, or those who have a history of mania, words move about in all directions possible, in a three-dimensional ‘soup’, making retrieval more fluid, less predictable.” Kay Redfield Jamison (2017, p. 279).

Features of the cognitive sphere in patients with a mixed episode of bipolar affective disorder

Background. Data of various meta-analyzes confirm that the majority of patients with bipolar affective disorder (BAD) have neurocognitive dysfunction, even during remission. According to the latest research, disturbed domains with moderate to pronounced changes are attention, verbal learning and memory, as well as executive functions, whereas premorbid intelligence may remain unchanged. The main body of research is devoted to the study of cognitive impairment in the first episode of BAD, in manic, depressive episodes and euthymia. At the same time, the features of cognitive dysfunction in mixed forms of biologically active substances remain insufficiently studied.
 Objective – to study the characteristics of the cognitive sphere in patients with a mixed episode of BAD.
 Materials and methods. With the help of battery tests (a test to memorize ten unrelated words; Rey-Osterreith Complex Figure Test; Verbal Fluency Test Digit Symbol Substitution Test; Trail making test), the cognitive functions of 25 patients with mixed episodes, 16 patients with manic episodes, and 15 patients with depressive episode of BAD.
 Results. Cognitive impairments were identified in all patients, regardless of the type of affective symptoms, in the form of a wide range of psychopathological phenomena, which are more pronounced in patients with a mixed episode BAD. The peculiarities of the phenomenological structure of cognitive impairment in patients with mixed phase BAD manifest themselves in the form of: a more pronounced deterioration of verbal memory, speed of information processing; more pronounced violations of spatial representations, impairment of visual memory, verbal associative performance and executive functions; reduction of attention and violations of its distribution.
 Conclusions. The findings suggest that the presence of depressive symptoms in the structure of mixed affect plays a dominant role in the formation of these disorders.

Modelling factors of urinary incontinence in institutional older adults with dementia.

This study applied structural equation modelling to explore the relationships among agitated behaviours, depression, cognitive function and activities of daily living, as well as associations between these factors and urinary incontinence). A high prevalence of urinary incontinence is found among institutional older adults with dementia. People with urinary incontinence suffer from increased financial burden and social isolation and experience reduced quality of life. Cross-sectional correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)statement. In total, 226 older adults with dementia were recruited through convenience sampling at 15 long-term care facilities in southern Taiwan. The urinary incontinence frequency, agitated behaviours, depression, cognitive function and activities of daily living were evaluated using bladder records, the Cohen-Mansfield Agitation Inventory, the Cornell Scale for Depression in Dementia, the Mini-Mental State Examination and the Barthel Index, respectively. Activities of daily living performance was found to be significantly associated with urinary incontinence; however, age, cognitive function, depression and agitated behaviours were not significantly related to urinary incontinence. Age did not have effects on any of the variables tested in this model, whereas activities of daily living performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between activities of daily living and agitated behaviours. Enhanced activities of daily living independency directly reduced urinary incontinence, improved cognitive function, decreased degrees of depression and indirectly reduced agitated behaviours. The findings could serve as a valuable reference for long-term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia.

The 12-item self-rating questionnaire for depressive mixed state (DMX-12) in relation to categorical diagnoses of mixed depression and mixed features

The 12-item self-rating questionnaire for depressive mixed state (DMX-12) in relation to categorical diagnoses of mixed depression and mixed features

Hippocampus Metabolic Disturbance and Autophagy Deficiency in Olfactory Bulbectomized Rats and the Modulatory Effect of Fluoxetine.

An olfactory bulbectomy (OBX) rodent is a widely-used model for depression (especially for agitated depression). The present study aims to investigate the hippocampus metabolic profile and autophagy-related pathways in OBX rats and to explore the modulatory roles of fluoxetine. OBX rats were given a 30-day fluoxetine treatment after post-surgery rehabilitation, and then behavioral changes were evaluated. Subsequently, the hippocampus was harvested for metabonomics analysis and Western blot detection. As a result, OBX rats exhibited a significantly increased hyperemotionality score and declined spatial memory ability. Fluoxetine reduced the hyperemotional response, but failed to restore the memory deficit in OBX rats. Sixteen metabolites were identified as potential biomarkers for the OBX model including six that were rectified by fluoxetine. Disturbed pathways were involved in amino acid metabolism, fatty acid metabolism, purine metabolism, and energy metabolism. In addition, autophagy was markedly inhibited in the hippocampus of OBX rats. Fluoxetine could promote autophagy by up-regulating the expression of LC3 II, beclin1, and p-AMPK/AMPK, and down-regulating the levels of p62, p-Akt/Akt, p-mTOR/mTOR, and p-ULK1/ULK1. Our findings indicated that OBX caused marked abnormalities in hippocampus metabolites and autophagy, and fluoxetine could partly redress the metabolic disturbance and enhance autophagy to reverse the depressive-like behavior, but not the memory deficits in OBX rats.

Urinary metabolic disturbance in the olfactory bulbectomized rats and the modulatory effects of fluoxetine

AimsThe present study aims to investigate the impacts of olfactory bulbectomy (OBX) on urinary metabolic profile and tryptophan metabolites in prefrontal cortex (PFC) of rats, and to explore the regulation effects of fluoxetine. Main methodsOBX model was developed by aspiration of olfactory bulbs. After fluoxetine treatment (10 mg/kg) for 14 days, urine samples were collected and behavior tests were applied. Tryptophan (TRP) metabolites and neurotransmitters in PFC were determined by prominence ultrafast liquid chromatography-QTRAP-mass spectrometry, and tryptophan hydroxylase 2 (TPH2) and indoleamine-2,3-dioxygenase 1 (IDO1) were evaluated by western blot. Urinary metabolites were analyzed by ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry-based metabonomics strategy. Key findingOBX rats showed hyperlocomotion in open field, hyperactivity in open arm and despair status, and fluoxetine reserved these behavioral abnormalities. The levels of TRP, 5-HIAA, 5-HIAA/5-HT ratio and DA increased, while kynurenine and 5-HT decreased in PFC of OBX rats. The activities of TPH2 and IDO1were inhibited after OBX. Twenty-six altered metabolites were identified as potential biomarkers in OBX rats involved in tryptophan metabolism, gut microbiota metabolism, energy metabolism, purine metabolism, ascorbate and aldarate metabolism, and tyrosine metabolism. Among them, 15 abnormal metabolites were corrected by fluoxetine to some extent. SignificanceOur results revealed that urinary metabolic profile changed greatly in OBX rats, and identified biomarkers might be helpful for the diagnosis of agitated depression. The regulation effects of fluoxetine on urinary metabolic profile and tryptophan metabolites in PFC might contribute to its antidepressant action in OBX rats.

ASENAPINE: PHARMACOLOGICAL ASPECTS AND ROLE IN PSYCHIATRIC DISORDERS

Schizophrenia and bipolar disorders are serious psychiatric disorders with substantial health risks. Asenapine is a new second-generation antipsychotic, available as a sublingual tablet, approved in Europe for the treatment of moderate-to-severe manic episodes in adults, and in US for manic or mixed episodes of bipolar I disorder in adults and adolescents. In this review, we searched the available literature to appreciate the role of asenapine in the management of psychiatric conditions such as bipolar disorders and schizophrenia and describe its mechanism of action, efficacy and tolerability. Asenapine has demonstrated efficacy in the management of bipolar disorders and schizophrenia, while a possible role in the management of borderline personality disorder and agitation needs further research. Asenapine has favourable side effects profile and combining with other pharmacological treatment in post-traumatic stress disorder has shown promising results. Asenapine fulfils important requirements of efficacy and tolerability as an anti-psychotic. These findings should support psychiatrists and pharmacists in the care of their patients while on asenapine.

Personalized Pharmacotherapy for Bipolar Disorder: How to Tailor Findings From Randomized Trials to Individual Patient-Level Outcomes.

The quest for "personalized medicine" in psychiatry has focused mainly on pursuing potential biomarkers such as pharmacogenetic predictors of drug response. However, the collective randomized trial database across phases of bipolar disorder allows one to identify clinical characteristics that inform the likelihood of desired treatment outcomes. In turn, those characteristics, termed moderators and mediators of drug response, enable those who administer treatment to construct clinical profiles that can help them tailor pharmacotherapies to the features of a given patient rather than simply to an overall diagnosis. Bipolar disorder typically involves more heterogeneous than uniform clinical presentations, partly because of its highly prevalent psychiatric and medical comorbid conditions. Further clinical diversity arises from characteristics such as bipolar I versus II disorder subtype, rapid cycling, mixed versus pure affective episodes, psychosis, anxiety, chronicity, cognitive dysfunction, and suicidality, among other distinguishing features. By coupling such profiles with an awareness of the psychotropic breadth of spectrum held by particular medications, clinicians can devise strategic combination therapy regimens, capitalizing on synergies and using drugs that exert multiple relevant effects, addressing comorbid conditions, incorporating medications that could offset adverse effects of other agents, and avoiding or deprescribing medication options that lack known evidence to target symptoms within the clinical profile of a given patient.

Development of the 12-item questionnaire for quantitative assessment of depressive mixed state (DMX-12).

BackgroundConventional categorical criteria have limitations in assessing the prevalence and severity of depressive mixed state (DMX). Thus, we have developed a new scale for screening and quantification of DMX and examined the symptomatological structure and severity of DMX in individuals with major depressive episode (MDE).MethodsSubjects were 154 patients with MDE (57 males and 97 females; age 13–83 years). Our original Japanese version of the self-administered 12-item questionnaire to assess DMX (DMX-12), together with the Quick Inventory of Depressive Symptomatology Self-Report Japanese version (QIDS-SR-J) and global assessment of functioning, were administered to each participant. The symptomatological structure of the DMX-12 was examined by exploratory factor analysis. Multiple regression analyses were used to analyze factors contributing to the DMX-12 scale. The relationships of this scale with categorical diagnoses (mixed depression by Benazzi and mixed features by DSM-5) were also investigated.ResultsA three-factor model of the DMX-12 was extracted from exploratory factor analysis, namely, “spontaneous instability”, “vulnerable responsiveness”, and “disruptive emotion/behavior”. Multiple regression analyses revealed that age was negatively correlated with total DMX-12 score, while bipolarity and the QIDS-SR-J score were positively correlated. A higher score on the disruptive emotion/behavior subscale was observed in patients with mixed depression and mixed features.ConclusionThe DMX-12 seems to be useful for screening DMX in conjunction with conventional categorical diagnoses. Severely depressed younger subjects with potential bipolarity are more likely to develop DMX. The disruptive emotion/behavior subscale of the DMX-12 may be the most helpful in distinguishing patients with DMX from non-mixed patients.