{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:37:20Z","timestamp":1790177840849,"version":"4.1.0"},"reference-count":38,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2015,11,1]],"date-time":"2015-11-01T00:00:00Z","timestamp":1446336000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.jp","clinicalkey.com","clinicalkey.es","clinicalkey.com.au","clinicalkey.fr","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Comprehensive Psychiatry"],"published-print":{"date-parts":[[2015,11]]},"DOI":"10.1016\/j.comppsych.2015.07.018","type":"journal-article","created":{"date-parts":[[2015,7,30]],"date-time":"2015-07-30T08:29:11Z","timestamp":1438244951000},"page":"15-21","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":24,"special_numbering":"C","title":["Onset polarity and illness course in bipolar I and II disorders: The predictive role of broadly defined mixed states"],"prefix":"10.1016","volume":"63","author":[{"given":"Antonio","family":"Tundo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Musetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Benedetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Berti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Massimetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Dell'Osso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.comppsych.2015.07.018_bb0005","series-title":"Manic\u2013depressive illness","author":"Goodwin","year":"2007"},{"issue":"4","key":"10.1016\/j.comppsych.2015.07.018_bb0010","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/j.1600-0447.2011.01818.x","article-title":"Predominant recurrence polarity among 928 adult international bipolar I disorder patients","volume":"125","author":"Baldessarini","year":"2012","journal-title":"Acta Psychiatr Scand"},{"key":"10.1016\/j.comppsych.2015.07.018_bb0015","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jad.2014.03.035","article-title":"Predominant polarity as a course specifier for bipolar disorder: a systematic review","volume":"163","author":"Carvalho","year":"2014","journal-title":"J Affect Disord"},{"issue":"6","key":"10.1016\/j.comppsych.2015.07.018_bb0020","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.comppsych.2006.03.009","article-title":"Clinical correlates of first-episode polarity in bipolar disorder","volume":"47","author":"Daban","year":"2006","journal-title":"Compr Psychiatry"},{"issue":"1","key":"10.1016\/j.comppsych.2015.07.018_bb0025","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/S0010-440X(00)90125-1","article-title":"Polarity of the first episode, clinical characteristics, and course of manic depressive illness: a systematic retrospective investigation of 320 bipolar I patients","volume":"41","author":"Perugi","year":"2000","journal-title":"Compr Psychiatry"},{"issue":"1","key":"10.1016\/j.comppsych.2015.07.018_bb0030","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1111\/j.1399-5618.2008.00654.x","article-title":"Polarity at illness onset in bipolar I disorder and clinical course of illness","volume":"11","author":"Forty","year":"2009","journal-title":"Bipolar Disord"},{"issue":"7","key":"10.1016\/j.comppsych.2015.07.018_bb0035","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.biopsych.2005.07.029","article-title":"Revisiting depressive-prone bipolar disorder: polarity of initial mood episode and disease course among bipolar I systematic treatment enhancement program for bipolar disorder participants","volume":"58","author":"Perlis","year":"2005","journal-title":"Biol Psychiatry"},{"issue":"1-3","key":"10.1016\/j.comppsych.2015.07.018_bb0040","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jad.2007.02.022","article-title":"Does first episode polarity predict risk for suicide attempt in bipolar disorder?","volume":"104","author":"Chaudhury","year":"2007","journal-title":"J Affect Disord"},{"issue":"4","key":"10.1016\/j.comppsych.2015.07.018_bb0045","doi-asserted-by":"crossref","first-page":"e561","DOI":"10.4088\/JCP.10m06504","article-title":"Clinical expression of bipolar disorder type I as a function of age and polarity at onset: convergent findings in samples from France and the United States","volume":"73","author":"Etain","year":"2012","journal-title":"J Clin Psychiatry"},{"key":"10.1016\/j.comppsych.2015.07.018_bb0050","article-title":"First-episode types in bipolar disorder: predictive associations with later illness","volume":"24","author":"Baldessarini","year":"2013","journal-title":"Acta Psychiatr Scand"},{"issue":"1","key":"10.1016\/j.comppsych.2015.07.018_bb0055","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/BF00344125","article-title":"The course of affective disorders. II. Typology of bipolar manic\u2013depressive illness","volume":"226","author":"Angst","year":"1978","journal-title":"Arch Psychiatr Nervenkr"},{"issue":"2","key":"10.1016\/j.comppsych.2015.07.018_bb0060","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1590\/S1516-44462009000200006","article-title":"Bipolar disorder first episode and suicidal behavior: are there differences according to type of suicide attempt?","volume":"31","author":"Neves","year":"2009","journal-title":"Rev Bras Psiquiatr"},{"issue":"1-3","key":"10.1016\/j.comppsych.2015.07.018_bb0065","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jad.2010.08.020","article-title":"Correlates of first-episode polarity in a French cohort of 1089 bipolar I disorder patients: role of temperaments and triggering events","volume":"129","author":"Azorin","year":"2011","journal-title":"J Affect Disord"},{"issue":"1","key":"10.1016\/j.comppsych.2015.07.018_bb0070","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/0165-1781(90)90054-9","article-title":"Evaluation of thyroid function in patients with rapid-cycling and non-rapid-cycling bipolar disorder","volume":"34","author":"Bartalena","year":"1990","journal-title":"Psychiatry Res"},{"issue":"2","key":"10.1016\/j.comppsych.2015.07.018_bb0075","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.comppsych.2008.07.004","article-title":"Risk factors associated with lifetime suicide attempts in bipolar I patients: findings from a French National Cohort","volume":"50","author":"Azorin","year":"2009","journal-title":"Compr Psychiatry"},{"issue":"1-3","key":"10.1016\/j.comppsych.2015.07.018_bb0080","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jad.2006.01.032","article-title":"Clinical and therapeutic implications of predominant polarity in bipolar disorder","volume":"93","author":"Colom","year":"2006","journal-title":"J Affect Disord"},{"issue":"5","key":"10.1016\/j.comppsych.2015.07.018_bb0085","doi-asserted-by":"crossref","first-page":"671","DOI":"10.4088\/JCP.09m05483yel","article-title":"Poor long-term prognosis in mixed bipolar patients: 10-year outcomes in the Vitoria prospective naturalistic study in Spain","volume":"72","author":"Gonzalez-Pinto","year":"2011","journal-title":"J Clin Psychiatry"},{"issue":"1-2","key":"10.1016\/j.comppsych.2015.07.018_bb0090","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.jad.2010.03.014","article-title":"Dissimilar morbidity following initial mania versus mixed-states in type-I bipolar disorder","volume":"126","author":"Baldessarini","year":"2010","journal-title":"J Affect Disord"},{"issue":"2","key":"10.1016\/j.comppsych.2015.07.018_bb0095","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.1399-5618.2004.00180.x","article-title":"Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation","volume":"7","author":"Kawa","year":"2005","journal-title":"Bipolar Disord"},{"issue":"10","key":"10.1016\/j.comppsych.2015.07.018_bb0100","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1176\/ajp.2006.163.10.1754","article-title":"Familiality of polarity at illness onset in bipolar affective disorder","volume":"163","author":"Kassem","year":"2006","journal-title":"Am J Psychiatry"},{"issue":"2","key":"10.1016\/j.comppsych.2015.07.018_bb0105","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.eurpsy.2003.09.008","article-title":"Toward a validation of a new definition of agitated depression as a bipolar mixed state (mixed depression)","volume":"19","author":"Benazzi","year":"2004","journal-title":"Eur Psychiatry"},{"key":"10.1016\/j.comppsych.2015.07.018_bb0110","series-title":"Diagnostic and statistical manual of mental disorders, fourth edition (DSM IV)","author":"American Psychiatric Association","year":"1994"},{"issue":"3","key":"10.1016\/j.comppsych.2015.07.018_bb0115","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S0193-953X(05)70095-2","article-title":"Agitated depression as a mixed state and the problem of melancholia","volume":"22","author":"Koukopoulos","year":"1999","journal-title":"Psychiatr Clin North Am"},{"key":"10.1016\/j.comppsych.2015.07.018_bb0120","series-title":"Structured clinical interview for the diagnostic and statistical manual","author":"First","year":"1997"},{"key":"10.1016\/j.comppsych.2015.07.018_bb0125","series-title":"\u201cQuo Vadis?\u201d Symposium, Sanofi Group; May 11\u201312; Montpellier, France","first-page":"91","article-title":"Major depression subcategories: their potentiality for clinical research. Diagnosis and treatment of depression","author":"Cassano","year":"1987"},{"key":"10.1016\/j.comppsych.2015.07.018_bb0130","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jad.2014.03.054","article-title":"Koukopoulos diagnostic criteria for mixed depression: a validation study","volume":"164","author":"Sani","year":"2014","journal-title":"J Affect Disord"},{"issue":"1","key":"10.1016\/j.comppsych.2015.07.018_bb0135","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1176\/appi.ajp.2012.12030301","article-title":"Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis","volume":"170","author":"Swann","year":"2013","journal-title":"Am J Psychiatry"},{"issue":"9","key":"10.1016\/j.comppsych.2015.07.018_bb0140","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1001\/archpsyc.1976.01770090052004","article-title":"Incidence and signficiance of mixed affective states in a bipolar population","volume":"33","author":"Himmelhoch","year":"1976","journal-title":"Arch Gen Psychiatry"},{"issue":"9","key":"10.1016\/j.comppsych.2015.07.018_bb0145","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1176\/appi.ajp.2007.05122032","article-title":"Adjunctive antidepressant use and symptomatic recovery among bipolar depressed patients with concomitant manic symptoms: findings from the STEP-BD","volume":"164","author":"Goldberg","year":"2007","journal-title":"Am J Psychiatry"},{"issue":"4","key":"10.1016\/j.comppsych.2015.07.018_bb0150","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1097\/JCP.0b013e318299d2d5","article-title":"Antidepressant response and subthreshold bipolarity in \"unipolar\" major depressive disorder: implications for practice and drug research","volume":"33","author":"Rihmer","year":"2013","journal-title":"J Clin Psychopharmacol"},{"issue":"1","key":"10.1016\/j.comppsych.2015.07.018_bb0155","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.jad.2013.05.077","article-title":"Association between the so-called \"activation syndrome\" and bipolar II disorder, a related disorder, and bipolar suggestive features in outpatients with depression","volume":"151","author":"Takeshima","year":"2013","journal-title":"J Affect Disord"},{"issue":"2","key":"10.1016\/j.comppsych.2015.07.018_bb0160","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/S0165-0327(03)00159-9","article-title":"Evaluating the inter-episode stability of depressive mixed states","volume":"81","author":"Sato","year":"2004","journal-title":"J Affect Disord"},{"issue":"7","key":"10.1016\/j.comppsych.2015.07.018_bb0165","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.euroneuro.2012.08.009","article-title":"Genetics of emergent suicidality during antidepressive treatment\u2014data from a naturalistic study on a large sample of inpatients with a major depressive episode","volume":"23","author":"Musil","year":"2013","journal-title":"Eur Neuropsychopharmacol"},{"issue":"1","key":"10.1016\/j.comppsych.2015.07.018_bb0170","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s00406-008-0834-7","article-title":"Does psychomotor agitation in major depressive episodes indicate bipolarity? Evidence from the Zurich Study","volume":"259","author":"Angst","year":"2009","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"issue":"1-3","key":"10.1016\/j.comppsych.2015.07.018_bb0175","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jad.2013.01.003","article-title":"The symptom structure of bipolar acute episodes: in search for the mixing link","volume":"149","author":"Pacchiarotti","year":"2013","journal-title":"J Affect Disord"},{"key":"10.1016\/j.comppsych.2015.07.018_bb0180","series-title":"Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5)","author":"American Psychiatric Association","year":"2013"},{"issue":"1","key":"10.1016\/j.comppsych.2015.07.018_bb0185","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/acps.12140","article-title":"DSM-5 criteria for depression with mixed features: a farewell to mixed depression","volume":"129","author":"Koukopoulos","year":"2014","journal-title":"Acta Psychiatr Scand"},{"issue":"10","key":"10.1016\/j.comppsych.2015.07.018_bb0190","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1176\/appi.ajp.2014.13111501","article-title":"The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer","volume":"171","author":"Viktorin","year":"2014","journal-title":"Am J Psychiatry"}],"container-title":["Comprehensive Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0010440X15001315?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0010440X15001315?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2018,9,20]],"date-time":"2018-09-20T11:20:15Z","timestamp":1537442415000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0010440X15001315"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,11]]},"references-count":38,"alternative-id":["S0010440X15001315"],"URL":"https:\/\/doi.org\/10.1016\/j.comppsych.2015.07.018","relation":{},"ISSN":["0010-440X"],"issn-type":[{"value":"0010-440X","type":"print"}],"subject":[],"published":{"date-parts":[[2015,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Onset polarity and illness course in bipolar I and II disorders: The predictive role of broadly defined mixed states","name":"articletitle","label":"Article Title"},{"value":"Comprehensive Psychiatry","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.comppsych.2015.07.018","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2015 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}