Mixed episodes are a volatile mix of lowered action threshold and "incredible" dysphoria that brings more suicidal ideation and attempts and more comorbid substance abuse disorders than euphoric, or "pure," mania, she added.
Dr. Suppes and colleagues conducted a study following 908 bipolar patients in the Stanley Foundation Bipolar Network for two years and found that their affective state was mixed hypomania at 4.2% of all office visits, depressed at 34% of visits, and hypomanic at 3.1%.
She said she hopes this empiric data will get into the DSM update as well.
"The diagnosis is being missed and folks aren't getting the treatment they need," she said.
