{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:21:22Z","timestamp":1790806882656,"version":"4.1.0"},"reference-count":80,"publisher":"Elsevier BV","issue":"1","license":[{"start":{"date-parts":[[2020,3,1]],"date-time":"2020-03-01T00:00:00Z","timestamp":1583020800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2020,3,1]],"date-time":"2020-03-01T00:00:00Z","timestamp":1583020800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","theclinics.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Psychiatric Clinics of North America"],"published-print":{"date-parts":[[2020,3]]},"DOI":"10.1016\/j.psc.2019.10.003","type":"journal-article","created":{"date-parts":[[2019,12,19]],"date-time":"2019-12-19T09:25:49Z","timestamp":1576747549000},"page":"27-46","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":14,"title":["Psychopathology of Mixed States"],"prefix":"10.1016","volume":"43","author":[{"given":"Sergio A.","family":"Barroilhet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Nassir","family":"Ghaemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.psc.2019.10.003_bib1","series-title":"Psicopatolog\u00eda Cl\u00ednica","author":"Schneider","year":"1997"},{"key":"10.1016\/j.psc.2019.10.003_bib2","volume":"vol. 1","author":"Goodwin","year":"2007"},{"issue":"1\u20133","key":"10.1016\/j.psc.2019.10.003_bib3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0165-0327(01)00429-3","article-title":"Bipolarity from ancient to modern times: conception, birth and rebirth","volume":"67","author":"Angst","year":"2001","journal-title":"J\u00a0Affect Disord"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib4","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":"4","key":"10.1016\/j.psc.2019.10.003_bib5","first-page":"332","article-title":"Mixed states: still a modern psychopathological syndrome?","volume":"21","author":"Tortorella","year":"2015","journal-title":"J\u00a0Psychopathol"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib6","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1176\/appi.ajp.2008.08050746","article-title":"Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD","volume":"166","author":"Goldberg","year":"2009","journal-title":"Am J Psychiatry"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib7","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/15622975.2017.1384850","article-title":"The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: acute and long-term treatment of mixed states in bipolar disorder","volume":"19","author":"Grunze","year":"2018","journal-title":"World J Biol Psychiatry"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib8","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1017\/S1092852916000869","article-title":"Mixed features in bipolar disorder","volume":"22","author":"Sol\u00e9","year":"2017","journal-title":"CNS Spectr"},{"issue":"4","key":"10.1016\/j.psc.2019.10.003_bib9","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1001\/archgenpsychiatry.2010.179","article-title":"Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder","volume":"68","author":"Perlis","year":"2011","journal-title":"Arch Gen Psychiatry"},{"issue":"8","key":"10.1016\/j.psc.2019.10.003_bib10","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1001\/archgenpsychiatry.2011.87","article-title":"Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study","volume":"68","author":"Angst","year":"2011","journal-title":"Arch Gen Psychiatry"},{"issue":"7\u20138","key":"10.1016\/j.psc.2019.10.003_bib11","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1111\/j.1399-5618.2011.00957.x","article-title":"Subthreshold bipolarity: diagnostic issues and challenges","volume":"13","author":"Nusslock","year":"2011","journal-title":"Bipolar Disord"},{"issue":"S2","key":"10.1016\/j.psc.2019.10.003_bib12","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/bdi.12700","article-title":"Modelling mood disorders: an ACE solution?","volume":"20","author":"Malhi","year":"2018","journal-title":"Bipolar Disord"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib13","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":"8","key":"10.1016\/j.psc.2019.10.003_bib14","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1111\/j.1399-5618.2008.00634.x","article-title":"The factor structure of clinical symptoms in mixed and manic episodes prior to and after antipsychotic treatment","volume":"10","author":"Harvey","year":"2008","journal-title":"Bipolar Disord"},{"issue":"5","key":"10.1016\/j.psc.2019.10.003_bib15","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.eurpsy.2004.04.019","article-title":"Dimensions of mania: differences between mixed and pure episodes","volume":"19","author":"Gonz\u00e1lez-Pinto","year":"2004","journal-title":"Eur Psychiatry"},{"issue":"1\u20132","key":"10.1016\/j.psc.2019.10.003_bib16","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jad.2012.05.061","article-title":"Multivariate analysis of bipolar mania: retrospectively assessed structure of bipolar I manic and mixed episodes in randomized clinical trial participants","volume":"144","author":"Swann","year":"2013","journal-title":"J\u00a0Affect Disord"},{"key":"10.1016\/j.psc.2019.10.003_bib17","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.jad.2014.11.016","article-title":"Phenomenological subtypes of mania and their relationships with substance use disorders","volume":"174","author":"G\u00fccl\u00fc","year":"2015","journal-title":"J\u00a0Affect Disord"},{"issue":"1\u20132","key":"10.1016\/j.psc.2019.10.003_bib18","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S0165-0327(02)00318-X","article-title":"Proposed multidimensional structure of mania: beyond the euphoric-dysphoric dichotomy","volume":"73","author":"Akiskal","year":"2003","journal-title":"J\u00a0Affect Disord"},{"issue":"2\u20133","key":"10.1016\/j.psc.2019.10.003_bib19","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S0165-0327(00)00228-7","article-title":"A\u00a0factor analysis of signs and symptoms of the manic episode with Bech\u2013Rafaelsen Mania and Melancholia Scales","volume":"64","author":"Rossi","year":"2001","journal-title":"J\u00a0Affect Disord"},{"issue":"12","key":"10.1016\/j.psc.2019.10.003_bib20","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.3109\/00048670903279853","article-title":"Factor structure of manic symptoms","volume":"43","author":"Gupta","year":"2009","journal-title":"Aust N Z J Psychiatry"},{"issue":"7","key":"10.1016\/j.psc.2019.10.003_bib21","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.eurpsy.2014.02.003","article-title":"Latent structure of the symptomatology of hospitalized patients with bipolar mania","volume":"29","author":"Filgueiras","year":"2014","journal-title":"Eur Psychiatry"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib22","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0165-0327(01)00441-4","article-title":"Toward a refined phenomenology of mania: combining clinician-assessment and self-report in the French EPIMAN study","volume":"67","author":"Akiskal","year":"2001","journal-title":"J\u00a0Affect Disord"},{"issue":"3","key":"10.1016\/j.psc.2019.10.003_bib23","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0165-1781(01)00232-3","article-title":"The contrasting influence of depressive and hyperthymic temperaments on psychometrically derived manic subtypes","volume":"101","author":"Perugi","year":"2001","journal-title":"Psychiatry Res"},{"issue":"3","key":"10.1016\/j.psc.2019.10.003_bib24","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1176\/ajp.156.3.426","article-title":"Phenomenology of mania: evidence for distinct depressed, dysphoric, and euphoric presentations","volume":"156","author":"Dilsaver","year":"1999","journal-title":"Am J Psychiatry"},{"issue":"6","key":"10.1016\/j.psc.2019.10.003_bib25","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1176\/appi.ajp.159.6.968","article-title":"Syndromes and phenomenological subtypes underlying acute mania: a factor analytic study of 576 manic patients","volume":"159","author":"Sato","year":"2002","journal-title":"Am J Psychiatry"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib26","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S0165-0327(02)00070-8","article-title":"Principal components of mania","volume":"76","author":"Gonz\u00e1lez-Pinto","year":"2003","journal-title":"J\u00a0Affect Disord"},{"issue":"3","key":"10.1016\/j.psc.2019.10.003_bib27","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.jad.2013.08.037","article-title":"Clinical subtypes of severe bipolar mixed states","volume":"151","author":"Perugi","year":"2013","journal-title":"J\u00a0Affect Disord"},{"issue":"4","key":"10.1016\/j.psc.2019.10.003_bib28","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.comppsych.2014.01.012","article-title":"Phenomenological subtypes of severe bipolar mixed states: a factor analytic study","volume":"55","author":"Perugi","year":"2014","journal-title":"Compr Psychiatry"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib29","doi-asserted-by":"crossref","first-page":"196","DOI":"10.4103\/psychiatry.IndianJPsychiatry_367_16","article-title":"A\u00a0factor analytical study report on mania from Nepal","volume":"59","author":"Shah","year":"2017","journal-title":"Indian J Psychiatry"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib30","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1001\/archpsyc.55.1.27","article-title":"A\u00a0factor analysis of the signs and symptoms of mania","volume":"55","author":"Cassidy","year":"1998","journal-title":"Arch Gen Psychiatry"},{"issue":"1\u20133","key":"10.1016\/j.psc.2019.10.003_bib31","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S0165-0327(01)00447-5","article-title":"Structure of mania: depressive, irritable, and psychotic clusters with different retrospectively-assessed course patterns of illness in randomized clinical trial participants","volume":"67","author":"Swann","year":"2001","journal-title":"J\u00a0Affect Disord"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib32","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/S0165-0327(98)00016-0","article-title":"Signs and symptoms of mania in pure and mixed episodes","volume":"50","author":"Cassidy","year":"1998","journal-title":"J\u00a0Affect Disord"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib33","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s40345-017-0103-7","article-title":"Anxiety, irritability, and agitation as indicators of bipolar mania with depressive symptoms: a post hoc analysis of two clinical trials","volume":"5","author":"Suppes","year":"2017","journal-title":"Int J Bipolar Disord"},{"key":"10.1016\/j.psc.2019.10.003_bib34","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\u00a0Affect Disord"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib35","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.jad.2013.04.025","article-title":"DSM-5 mixed specifier for manic episodes: evaluating the effect of depressive features on severity and treatment outcome using asenapine clinical trial data","volume":"150","author":"McIntyre","year":"2013","journal-title":"J\u00a0Affect Disord"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib36","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/1471-244X-11-137","article-title":"Signs and symptoms of acute mania: a factor analysis","volume":"11","author":"Hanwella","year":"2011","journal-title":"BMC Psychiatry"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib37","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jad.2007.09.010","article-title":"Symptom structure of acute mania: a factor study of the 24-item Brief Psychiatric Rating Scale in a national sample of patients hospitalized for a manic episode","volume":"108","author":"Picardi","year":"2008","journal-title":"J\u00a0Affect Disord"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib38","first-page":"46","article-title":"Phenomenology of Mania - A factor analysis approach","volume":"43","author":"Kumar","year":"2001","journal-title":"Indian J Psychiatry"},{"issue":"3","key":"10.1016\/j.psc.2019.10.003_bib39","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1159\/000120987","article-title":"Frequency of dysphoria and mixed states","volume":"41","author":"Bertschy","year":"2008","journal-title":"Psychopathology"},{"issue":"3","key":"10.1016\/j.psc.2019.10.003_bib40","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1002\/j.2051-5545.2009.tb00245.x","article-title":"Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features","volume":"8","author":"Swann","year":"2009","journal-title":"World Psychiatry"},{"issue":"2\u20133","key":"10.1016\/j.psc.2019.10.003_bib41","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.jad.2008.02.014","article-title":"Psychotic symptoms in patients with bipolar mania","volume":"111","author":"Canuso","year":"2008","journal-title":"J\u00a0Affect Disord"},{"issue":"2\u20133","key":"10.1016\/j.psc.2019.10.003_bib42","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/S0165-0327(98)00113-X","article-title":"Gender, temperament, and the clinical picture in dysphoric mixed mania: findings from a French national study (EPIMAN)","volume":"50","author":"Akiskal","year":"1998","journal-title":"J\u00a0Affect Disord"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib43","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1600-0447.2005.00692.x","article-title":"Evidence for three distinct classes of \u2018typical\u2019, \u2018psychotic\u2019 and \u2018dual\u2019 mania: results from the EMBLEM study","volume":"113","author":"Haro","year":"2006","journal-title":"Acta Psychiatr Scand"},{"issue":"4","key":"10.1016\/j.psc.2019.10.003_bib44","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.pnpbp.2007.02.015","article-title":"Delineation of the clinical picture of Dysphoric\/Mixed Hypomania","volume":"31","author":"Benazzi","year":"2007","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"issue":"10","key":"10.1016\/j.psc.2019.10.003_bib45","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1001\/archpsyc.62.10.1089","article-title":"Mixed hypomania in 908 patients with bipolar disorder evaluated prospectively in the Stanley Foundation Bipolar Treatment Network: a sex-specific phenomenon","volume":"62","author":"Suppes","year":"2005","journal-title":"Arch Gen Psychiatry"},{"key":"10.1016\/j.psc.2019.10.003_bib46","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jad.2019.05.033","article-title":"Racing thoughts revisited: a key dimension of activation in bipolar disorder","volume":"255","author":"Weiner","year":"2019","journal-title":"J\u00a0Affect Disord"},{"issue":"10","key":"10.1016\/j.psc.2019.10.003_bib47","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"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib48","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jad.2004.07.006","article-title":"Irritable-hostile depression: further validation as a bipolar depressive mixed state","volume":"84","author":"Benazzi","year":"2005","journal-title":"J\u00a0Affect Disord"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib49","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.pnpbp.2007.08.005","article-title":"A\u00a0tetrachoric factor analysis validation of mixed depression","volume":"32","author":"Benazzi","year":"2008","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib50","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1176\/appi.ajp.2008.08030322","article-title":"Correlates of treatment-emergent mania associated with antidepressant treatment in bipolar depression","volume":"166","author":"Frye","year":"2009","journal-title":"Am J Psychiatry"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib51","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S0165-0327(02)00103-9","article-title":"Dimensional psychopathology of depression: detection of an \u2018activation\u2019 dimension in unipolar depressed outpatients","volume":"84","author":"Biondi","year":"2005","journal-title":"J\u00a0Affect Disord"},{"issue":"2\u20133","key":"10.1016\/j.psc.2019.10.003_bib52","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/S0165-0327(02)00172-6","article-title":"Irritable psychomotor elation in depressed inpatients: a factor validation of mixed depression","volume":"84","author":"Sato","year":"2005","journal-title":"J\u00a0Affect Disord"},{"issue":"4","key":"10.1016\/j.psc.2019.10.003_bib53","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 \u2018depressive mixed state\u2019 as bipolar spectrum","volume":"107","author":"Sato","year":"2003","journal-title":"Acta Psychiatr Scand"},{"issue":"5","key":"10.1016\/j.psc.2019.10.003_bib54","doi-asserted-by":"crossref","first-page":"712","DOI":"10.4088\/JCP.v67n0504","article-title":"Agitated \u201cunipolar\u201d major depression: prevalence, phenomenology, and outcome","volume":"67","author":"Maj","year":"2006","journal-title":"J\u00a0Clin Psychiatry"},{"key":"10.1016\/j.psc.2019.10.003_bib55","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jpsychires.2019.05.014","article-title":"The role of overlapping excitatory symptoms in major depression: are they relevant for the diagnosis of mixed state?","volume":"115","author":"Brancati","year":"2019","journal-title":"J\u00a0Psychiatr Res"},{"issue":"6","key":"10.1016\/j.psc.2019.10.003_bib56","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1159\/000107559","article-title":"Evidence for two types of bipolar depression using a dimensional approach","volume":"76","author":"Henry","year":"2007","journal-title":"Psychother Psychosom"},{"issue":"9","key":"10.1016\/j.psc.2019.10.003_bib57","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1080\/00048670903107666","article-title":"Exploring clinical characteristics of bipolar depression: internal structure of the bipolar depression rating scale","volume":"43","author":"Chang","year":"2009","journal-title":"Aust N Z J Psychiatry"},{"issue":"433","key":"10.1016\/j.psc.2019.10.003_bib58","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/j.1600-0447.2007.00959.x","article-title":"Defining melancholia: the primacy of psychomotor disturbance","author":"Parker","year":"2007","journal-title":"Acta Psychiatr Scand Suppl"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib59","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/S0165-0327(01)00437-2","article-title":"Origin and development of concepts of bipolar mixed states","volume":"67","author":"Marneros","year":"2001","journal-title":"J\u00a0Affect Disord"},{"key":"10.1016\/j.psc.2019.10.003_bib60","series-title":"Bipolar disorders: mixed states, rapid-cycling, and atypical forms","first-page":"157","article-title":"Agitated depression: spontaneous and induced","author":"Koukopoulos","year":"2005"},{"key":"10.1016\/j.psc.2019.10.003_bib61","first-page":"287","article-title":"The concept of mixed state in bipolar disorder: from Kraepelin to DSM-5","volume":"19","author":"Maina","year":"2013","journal-title":"J\u00a0Psychopathol"},{"key":"10.1016\/j.psc.2019.10.003_bib62","series-title":"Bipolar disorders: mixed states, rapid-cycling, and atypical forms","first-page":"45","article-title":"Emerging concepts of mixed states: a longitudinal perspective","author":"Perugi","year":"2005"},{"key":"10.1016\/j.psc.2019.10.003_bib63","series-title":"Diagnostic criteria for schizophrenic and affective psychoses","author":"Berner","year":"1983"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib64","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1159\/000284485","article-title":"Psychopathological concepts of dysphoria","volume":"20","author":"Berner","year":"1987","journal-title":"Psychopathology"},{"issue":"4","key":"10.1016\/j.psc.2019.10.003_bib65","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1034\/j.1399-5618.2000.020404.x","article-title":"A\u00a0theoretical reappraisal of mixed states: dysphoria as a third dimension","volume":"2","author":"Dayer","year":"2000","journal-title":"Bipolar Disord"},{"issue":"Suppl 1 Pt A","key":"10.1016\/j.psc.2019.10.003_bib66","doi-asserted-by":"crossref","first-page":"632A","DOI":"10.1097\/00002826-199201001-00327","article-title":"The distinctive mixed states of bipolar I, II, and III","volume":"15","author":"Akiskal","year":"1992","journal-title":"Clin Neuropharmacol"},{"issue":"3","key":"10.1016\/j.psc.2019.10.003_bib67","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/S0193-953X(05)70093-9","article-title":"The evolving bipolar spectrum: prototypes I, II, III, and IV","volume":"22","author":"Akiskal","year":"1999","journal-title":"Psychiatr Clin North Am"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib68","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.jad.2013.06.041","article-title":"Affective temperaments are associated with specific clusters of symptoms and psychopathology: a cross-sectional study on bipolar disorder inpatients in acute manic, mixed, or depressive relapse","volume":"151","author":"Iasevoli","year":"2013","journal-title":"J\u00a0Affect Disord"},{"key":"10.1016\/j.psc.2019.10.003_bib69","series-title":"Bipolar disorders: mixed states, rapid-cycling, and atypical forms","author":"Marneros","year":"2005"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib70","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.eurpsy.2008.07.006","article-title":"The primacy of mania: a reconsideration of mood disorders","volume":"24","author":"Koukopoulos","year":"2009","journal-title":"Eur Psychiatry"},{"issue":"3","key":"10.1016\/j.psc.2019.10.003_bib71","doi-asserted-by":"crossref","first-page":"402","DOI":"10.2174\/1570159X14666160621113432","article-title":"Athanasios koukopoulos\u2019 psychiatry: the primacy of mania and the limits of antidepressants","volume":"15","author":"Ghaemi","year":"2017","journal-title":"Curr Neuropharmacol"},{"issue":"2","key":"10.1016\/j.psc.2019.10.003_bib72","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1001\/jamapsychiatry.2016.3459","article-title":"Activation in bipolar disorders: a systematic review","volume":"74","author":"Scott","year":"2017","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib73","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1176\/ajp.154.1.4","article-title":"Psychomotor symptoms of depression","volume":"154","author":"Sobin","year":"1997","journal-title":"Am J Psychiatry"},{"key":"10.1016\/j.psc.2019.10.003_bib74","series-title":"Psychopathology and the brain","first-page":"265","article-title":"Psychopathology and neurobiology of manic-depressive disorders","author":"Carrol","year":"1991"},{"key":"10.1016\/j.psc.2019.10.003_bib75","series-title":"Psicopatolog\u00eda y Semiolog\u00eda Psiqui\u00e1trica","author":"Capponi","year":"1987"},{"issue":"3","key":"10.1016\/j.psc.2019.10.003_bib76","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"},{"issue":"2-3","key":"10.1016\/j.psc.2019.10.003_bib77","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0165-0327(99)00010-5","article-title":"Psychomotor agitation: poorly de\ufb01ned and badly measured","volume":"55","author":"Day","year":"1999","journal-title":"J\u00a0Affect Disord"},{"issue":"1","key":"10.1016\/j.psc.2019.10.003_bib78","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.psc.2011.11.008","article-title":"The varieties of depressive experience: diagnosing mood disorders","volume":"35","author":"Ghaemi","year":"2012","journal-title":"Psychiatr Clin North Am"},{"key":"10.1016\/j.psc.2019.10.003_bib79","series-title":"Trastornos bipolares","first-page":"151","article-title":"Estados mixtos","author":"Risco","year":"2006"},{"issue":"4","key":"10.1016\/j.psc.2019.10.003_bib80","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/bdi.12502","article-title":"Mixed mood: the not so united states?","volume":"19","author":"Malhi","year":"2017","journal-title":"Bipolar Disord"}],"container-title":["Psychiatric Clinics of North America"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0193953X19300966?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0193953X19300966?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T01:38:35Z","timestamp":1759282715000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0193953X19300966"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":80,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,3]]}},"alternative-id":["S0193953X19300966"],"URL":"https:\/\/doi.org\/10.1016\/j.psc.2019.10.003","relation":{},"ISSN":["0193-953X"],"issn-type":[{"value":"0193-953X","type":"print"}],"subject":[],"published":{"date-parts":[[2020,3]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Psychopathology of Mixed States","name":"articletitle","label":"Article Title"},{"value":"Psychiatric Clinics of North America","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.psc.2019.10.003","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2019 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}