{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T03:31:36Z","timestamp":1788406296998,"version":"build-2803163510"},"reference-count":47,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,12,6]],"date-time":"2021-12-06T00:00:00Z","timestamp":1638748800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The criteria of the <jats:italic>Diagnostic and Statistical Manual of Mental Disorders<\/jats:italic> 5th edition \u201cwith mixed features specifier\u201d (DSM\u20105 MFS) are considered controversial since they include only typical manic symptoms. By contrast, Koukopoulos developed an alternative model of mixed depression (MxD) focusing primarily on the excitatory component.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare DSM\u20105 MFS and Koukopoulos' MxD (KMxD) in terms of prevalence, associated clinical variables, and discriminative capacity for bipolar depression in patients with major depressive episode (MDE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 300 patients with MDE\u2014155 with major depressive disorder and 145 with bipolar disorder (BD)\u2014were recruited. The discriminative capacity of DSM\u20105 MFS and KMxD criteria for BD was estimated using the area under the curves of receiver operating characteristic (ROC_AUC). The clinical variables associated with these two diagnostic constructs were assessed by performing a logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 44 and 165 patients met the DSM\u20105 MFS and KMxD criteria, respectively. The ROC_AUCs and their confidence intervals for BD according to DSM\u20105 MFS and KMxD were 77.0% (72.0%\u201082.1%) and 71.9% (66.2%\u201077.7%), respectively. The optimal thresholds (combining sensitivity and specificity measures) for BD diagnosis were \u22651 (77%\/68%) for DSM\u20105 MFS and \u22653\u00a0symptoms (78%\/66%) for KMxD. However, considering the DSM\u20105 MFS cut\u2010off (\u22653\u00a0symptoms), the specificity (97%) increased at the expense of sensitivity (26%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>KMxD and DSM\u20105\u2010MFS showed an overlapping discriminative capacity for bipolar depression. The current diagnostic threshold of DSM\u20105 MFS did not prove to be very inclusive, if compared with the greater diagnostic sensitivity of KMxD, which also yielded better association with clinical variables related to mixedness.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.13166","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T23:06:51Z","timestamp":1638313611000},"page":"530-538","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Which mixed depression model? 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