{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:47:15Z","timestamp":1790884035286,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,6,3]],"date-time":"2018-06-03T00:00:00Z","timestamp":1527984000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Aretaeus Foundation of Rome"},{"name":"Bruce J. Anderson Foundation"},{"name":"McLean Private Donors Research Fund"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess differences between subjects with vs. without mixed features in major affective disorders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In 3099 out\u2010patient subjects with <jats:styled-content style=\"fixed-case\">DSM<\/jats:styled-content>\u20105 major depressive disorder (<jats:styled-content style=\"fixed-case\">MDD<\/jats:styled-content>,<jats:italic> n<\/jats:italic>\u00a0=\u00a01921) or bipolar disorders (<jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>,<jats:italic> n<\/jats:italic>\u00a0=\u00a01178), we compared those with (Mx) vs. without (Non\u2010Mx) mixed features (agitated\u2010irritable depression or dysphoric [hypo]mania) in an index episode.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Prevalence of Mx averaged 21.9% [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 20.5\u201323.4] overall, ranking: <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>\u00a0&gt;\u00a0<jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010I\u00a0&gt;\u00a0<jats:styled-content style=\"fixed-case\">MDD<\/jats:styled-content>, and in <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content> depression \u2265 [hypo]mania\u00a0&gt;\u00a0<jats:styled-content style=\"fixed-case\">MDD<\/jats:styled-content>. Mx subjects were significantly more likely than Non\u2010Mx cases to (i) have other mixed episodes, (ii) have higher irritable and agitated ratings, (iii) have more substance abuse, (iv) switch into mixed episodes, (v) have more suicide attempts and higher suicidal ratings, (vi) change diagnosis from depression to <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>, (vii) have higher hypomania scores when depressed or depression scores when [hypo]manic, (viii) be unmarried or separated with fewer children and siblings, (ix) be diagnosed more with <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content> than <jats:styled-content style=\"fixed-case\">MDD<\/jats:styled-content>, (x) be unemployed, (xi) have <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>, suicide and divorce among first\u2010degree relatives, (xii) be female, (xiii) be younger at illness\u2010onset. Both <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">MDD<\/jats:styled-content> Mx subjects also received antidepressants less, but antipsychotics and mood\u2010stabilizers more, alone and in combination with antidepressants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Mood disorder subjects with agitated\u2010irritable depression or dysphoric [hypo]mania differed from those without such mixed features, including having a less favorable clinical course and repeated mixed episodes. They may represent a distinct and prevalent, syndromal clinical subtype with prognostic and therapeutic significance.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acps.12911","type":"journal-article","created":{"date-parts":[[2018,6,4]],"date-time":"2018-06-04T03:33:51Z","timestamp":1528083231000},"page":"243-252","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Characteristics of depressive and bipolar disorder patients with mixed features"],"prefix":"10.1111","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1624-0522","authenticated-orcid":false,"given":"L.","family":"Tondo","sequence":"first","affiliation":[{"name":"International Consortium for Psychotic &amp; Mood Disorders Research Mailman Research Center McLean Hospital Belmont MA USA"},{"name":"Department of Psychiatry Harvard Medical School Boston MA USA"},{"name":"Lucio Bini Mood Disorder Centers Cagliari, Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. 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