@article{ref1,
title="Prevalence rates and clinical implications of bipolar disorder "with mixed features" as defined by DSM-5",
journal="Journal of affective disorders",
year="2014",
author="Shim, In Hee and Woo, Young Sup and Bahk, Won-Myong",
volume="173C",
number="",
pages="120-125",
abstract="BACKGROUND: We investigated the increase in the prevalence of bipolar disorder with mixed features following the replacement of DSM-IV-TR criteria with DSM-5 criteria. Additionally, we examined the clinical implications of the use of &quot;with mixed features&quot; as a specifier with bipolar disorder. <br><br>METHOD: We retrospectively reviewed medical charts from 2003 to 2013. A total of 331 patients diagnosed with bipolar disorder using the DSM-IV TR were enrolled and categorized into four groups: manic/hypomanic with mixed features, manic/hypomanic without mixed features, depressed with mixed features, and depressed without mixed features. These classifications were made in accordance with the DSM-5 definition of bipolar disorder &quot;with mixed features.&quot; Changes in the prevalence, demographic and clinical characteristics were compared among the groups. <br><br>RESULTS: The prevalence rates of mixed features were significantly different when using the DSM-5 criteria vs. the DSM-IV-TR criteria. Patients with mixed features had a younger age of onset, younger age at hospitalization, more frequent hospitalizations for mixed episodes, and greater suicide risk compared with patients without mixed features. LIMITATIONS: Retrospective study may have resulted in under diagnosis of mixed states. <br><br>CONCLUSIONS: An approximately three-fold greater risk for mixed features was observed in patients with bipolar disorder when using the DSM-5 criteria than when using the DSM-IV-TR criteria. The additional patients may represent patients with sub-syndromal mixed features and could indicate that patients with mixed features are underdiagnosed.<p /><p>Language: en</p>",
language="en",
issn="0165-0327",
doi="10.1016/j.jad.2014.10.061",
url="http://dx.doi.org/10.1016/j.jad.2014.10.061"
}