{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:51:06Z","timestamp":1792000266346,"version":"4.4.0"},"reference-count":43,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Affective Disorders"],"published-print":{"date-parts":[[2026,4]]},"DOI":"10.1016\/j.jad.2025.120929","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T16:50:18Z","timestamp":1766508618000},"page":"120929","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":6,"special_numbering":"C","title":["Mixed features in depressive and bipolar disorders: An updated systematic review"],"prefix":"10.1016","volume":"398","author":[{"given":"Veronica","family":"Grasso","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Hernandorena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micaela","family":"Dines","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Tondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross J.","family":"Baldessarini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"V\u00e1zquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jad.2025.120929_bb0005","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jad.2004.12.004","article-title":"Agitated \u201cunipolar\u201d depression re-conceptualized as a depressive mixed state: implications for the antidepressant-suicide controversy","volume":"85","author":"Akiskal","year":"2005","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0010","series-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"1980"},{"key":"10.1016\/j.jad.2025.120929_bb0015","series-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"1994"},{"key":"10.1016\/j.jad.2025.120929_bb0025","series-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2013"},{"key":"10.1016\/j.jad.2025.120929_bb0030","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/s00406-013-0393-4","article-title":"Evidence-based definitions of bipolar-I and bipolar-II disorders among 5635 patients with major depressive episodes in the Bridge Study","volume":"263","author":"Angst","year":"2013","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"10.1016\/j.jad.2025.120929_bb0035","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.comppsych.2004.07.034","article-title":"Family history validation of a definition of mixed depression","volume":"46","author":"Benazzi","year":"2005","journal-title":"Compr. Psychiatry"},{"key":"10.1016\/j.jad.2025.120929_bb0040","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13750-017-0102-2","article-title":"Eligibility screening in evidence synthesis of environmental management topics","volume":"6","author":"Frampton","year":"2017","journal-title":"Environ. Evid."},{"key":"10.1016\/j.jad.2025.120929_bb0045","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1176\/appi.ajp.2008.08050746","article-title":"Manic symptoms during depressive episodes in 1380 patients with bipolar disorder: findings from the STEP-BD","volume":"166","author":"Goldberg","year":"2009","journal-title":"Am. J. Psychiatry"},{"key":"10.1016\/j.jad.2025.120929_bb0050","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajp.2022.103439","article-title":"A comparative study of prevalence of mixed features in patients with unipolar and bipolar depression","volume":"81","author":"Grover","year":"2023","journal-title":"Asian J. Psychiatr."},{"key":"10.1016\/j.jad.2025.120929_bb0055","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.jad.2017.08.040","article-title":"The safety and tolerability of cariprazine in patients with manic or mixed episodes associated with bipolar I disorder: a 16-week open-label study","volume":"225","author":"Ketter","year":"2018","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0060","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/acps.12563","article-title":"More inclusive bipolar mixed depression definitions by requiring fewer non-overlapping mood elevation symptoms","volume":"134","author":"Kim","year":"2016","journal-title":"Acta Psychiatr. Scand."},{"key":"10.1016\/j.jad.2025.120929_bb0065","first-page":"373","article-title":"Mixed depression: diagnosis and classification","volume":"14","author":"Koukopoulos","year":"1999","journal-title":"Eur. Psychiatry"},{"key":"10.1016\/j.jad.2025.120929_bb0070","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."},{"key":"10.1016\/j.jad.2025.120929_bb0075","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/j.1600-0447.2007.00963.x","article-title":"Melancholia agitata and mixed depression","volume":"433","author":"Koukopoulos","year":"2007","journal-title":"Acta Psychiatr. Scand. Suppl."},{"key":"10.1016\/j.jad.2025.120929_bb0080","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1192\/bjp.bp.112.124404","article-title":"Mixed features of depression: why DSM-5 is wrong (and so was DSM-IV)","volume":"203","author":"Koukopoulos","year":"2013","journal-title":"Br. J. Psychiatry"},{"key":"10.1016\/j.jad.2025.120929_bb0085","doi-asserted-by":"crossref","DOI":"10.1002\/brb3.2313","article-title":"Reliability and validity of clinically useful depression outcome scale identifying mixed features in patients with manic episode","volume":"11","author":"Li","year":"2021","journal-title":"Brain Behav."},{"issue":"7","key":"10.1016\/j.jad.2025.120929_bb0090","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1000100","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration","volume":"6","author":"Liberati","year":"2009","journal-title":"PLoS Med."},{"key":"10.1016\/j.jad.2025.120929_bb0095","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.jad.2014.09.026","article-title":"Prevalence and illness characteristics of DSM-5-defined mixed features in adults with major depressive disorder and bipolar disorder: results from the International Mood Disorders Collaborative Project","volume":"172","author":"McIntyre","year":"2015","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0100","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/j.jad.2019.07.020","article-title":"Cariprazine for the treatment of bipolar mania with mixed features: a post hoc pooled analysis of three trials","volume":"257","author":"McIntyre","year":"2019","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0105","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1176\/appi.ajp.2016.15091119","article-title":"Mixed depression in bipolar disorder: prevalence rate and clinical correlates during naturalistic follow-up in the Stanley Bipolar Network","volume":"173","author":"Miller","year":"2016","journal-title":"Am. J. Psychiatry"},{"key":"10.1016\/j.jad.2025.120929_bb0110","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1111\/bdi.13166","article-title":"Which mixed depression model? A comparison between DSM-5-defined mixed features and Koukopoulos\u2019 criteria","volume":"24","author":"Mineo","year":"2022","journal-title":"Bipolar Disord."},{"issue":"7","key":"10.1016\/j.jad.2025.120929_bb0115","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med."},{"key":"10.1016\/j.jad.2025.120929_bb0120","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"10.1016\/j.jad.2025.120929_bb0125","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1017\/S0033291712000281","article-title":"Proposed DSM-5 mixed features are associated with greater likelihood of remission in outpatients with major depressive disorder","volume":"44","author":"Perlis","year":"2014","journal-title":"Psychol. Med."},{"key":"10.1016\/j.jad.2025.120929_bb0130","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/S0165-0327(01)00443-8","article-title":"Clinical characterization of depressive mixed state in bipolar-I patients","volume":"67","author":"Perugi","year":"2001","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0135","doi-asserted-by":"crossref","first-page":"e351","DOI":"10.4088\/JCP.14m09092","article-title":"Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study","volume":"76","author":"Perugi","year":"2015","journal-title":"J. Clin. Psychiatry"},{"key":"10.1016\/j.jad.2025.120929_bb0140","doi-asserted-by":"crossref","DOI":"10.4088\/JCP.24m15445","article-title":"Mixed features and nonfatal suicide attempt among individuals with major depressive episode: insights from the French MHGP survey","volume":"85","author":"Peyre","year":"2024","journal-title":"J. Clin. Psychiatry"},{"key":"10.1016\/j.jad.2025.120929_bb0145","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1177\/0004867415585583","article-title":"Making sense of DSM-5 mania with depressive features","volume":"49","author":"Reinares","year":"2015","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"10.1016\/j.jad.2025.120929_bb0150","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1034\/j.1600-0447.2003.00051.x","article-title":"Frequency of manic symptoms during a depressive episode and unipolar \u201cdepressive mixed state\u201d as bipolar spectrum","volume":"107","author":"Sato","year":"2003","journal-title":"Acta Psychiatr. Scand."},{"key":"10.1016\/j.jad.2025.120929_bb0155","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jad.2014.10.061","article-title":"Prevalence rates and clinical implications of bipolar disorder \u201cwith mixed features\u201d as defined by DSM-5","volume":"173","author":"Shim","year":"2015","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0160","doi-asserted-by":"crossref","DOI":"10.1002\/mpr.1773","article-title":"The prevalence and diagnostic classification of mixed features in patients with major depressive episodes: a multicenter study based on the DSM-5","volume":"28","author":"Shim","year":"2019","journal-title":"Int. J. Methods Psychiatr. Res."},{"key":"10.1016\/j.jad.2025.120929_bb0165","doi-asserted-by":"crossref","first-page":"678","DOI":"10.3390\/brainsci10100678","article-title":"The 12-item self-rating questionnaire for depressive mixed state (DMX-12) for screening of mixed depression and mixed features","volume":"10","author":"Shinzato","year":"2020","journal-title":"Brain Sci."},{"key":"10.1016\/j.jad.2025.120929_bb0170","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1111\/bdi.70016","article-title":"What is the depressive mixed state? Associated factors beyond bipolarity","volume":"27","author":"Takeshima","year":"2025","journal-title":"Bipolar Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0175","first-page":"123","article-title":"DSM-5-defined \u201cmixed features\u201d and Benazzi\u2019s mixed depression: which is practically useful for predicting bipolarity?","volume":"176","author":"Takeshima","year":"2015","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0180","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jad.2017.03.070","article-title":"Bipolar mixed features: results from the Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE) study","volume":"217","author":"Tohen","year":"2017","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0185","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.psc.2019.10.008","article-title":"Suicidal behavior associated with mixed features in major mood disorders","volume":"43","author":"Tondo","year":"2020","journal-title":"Psychiatr. Clin. North Am."},{"key":"10.1016\/j.jad.2025.120929_bb0190","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1080\/10673220500174833","article-title":"Manic-depressive illness: evolution in Kraepelin\u2019s Textbook, 1883\u20131926","volume":"13","author":"Trede","year":"2005","journal-title":"Harv. Rev. Psychiatry"},{"key":"10.1016\/j.jad.2025.120929_bb0195","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/j.jad.2017.09.006","article-title":"Mixed symptoms in major depressive and bipolar disorders: a systematic review","volume":"225","author":"V\u00e1zquez","year":"2018","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0200","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.jad.2013.12.031","article-title":"Phenomenology of manic episodes according to the presence or absence of depressive features as defined in DSM-5","volume":"156","author":"Vieta","year":"2014","journal-title":"J. Affect. Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0205","first-page":"471","article-title":"\u00dcber die sogenannten Mischzust\u00e4nde der Manie und Melancholie","volume":"47","author":"Weygandt","year":"1890","journal-title":"Allg. Z. Psychiatr. Psychisch-Gerichtl. Med."},{"key":"10.1016\/j.jad.2025.120929_bb0210","series-title":"\u00dcber die Mischzust\u00e4nde des manisch-depressiven Irreseins","author":"Weygandt","year":"1899"},{"key":"10.1016\/j.jad.2025.120929_bb0215","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1111\/bdi.70049","article-title":"Efficacy of pharmacological interventions in the treatment of major depressive disorder and bipolar depression with mixed features: a systematic review","volume":"27","author":"Xiao","year":"2025","journal-title":"Bipolar Disord."},{"key":"10.1016\/j.jad.2025.120929_bb0220","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1111\/bdi.13436","article-title":"Validity of the DSM-5 mixed features specifier interview","volume":"26","author":"Zimmerman","year":"2024","journal-title":"Bipolar Disord."}],"container-title":["Journal of Affective Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0165032725023717?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0165032725023717?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T13:13:00Z","timestamp":1781701980000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0165032725023717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":43,"alternative-id":["S0165032725023717"],"URL":"https:\/\/doi.org\/10.1016\/j.jad.2025.120929","relation":{},"ISSN":["0165-0327"],"issn-type":[{"value":"0165-0327","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Mixed features in depressive and bipolar disorders: An updated systematic review","name":"articletitle","label":"Article Title"},{"value":"Journal of Affective Disorders","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jad.2025.120929","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"120929"}}