Mixed Features in Depression: The Unmet Needs of Diagnostic and Statistical Manual of Mental Disorders Fifth Edition.

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition introduced the specifier "with mixed features" including 3 or more nonoverlapping typical manic symptoms during a major depressive episode in bipolar disorder type I or II or unipolar major depressive disorder. Excluding overlapping excitatory symptoms, which are frequently observed in mixed depression, leaves many patients with mixed depression undiagnosed. As a consequence, alternative diagnostic criteria have been proposed, claiming for the inclusion in the rubric of mixed features the following symptoms: psychomotor agitation, mood lability, and aggressiveness. A deeper diagnostic reconsideration of mixed features in depression should be provided by the new nosologic classification systems.
Competing Interests: Disclosure Dr I. Pacchiarotti has received CME-related honoraria or consulting fees from ADAMED, Janssen-Cilag, and Lundbeck. Dr A. Murru has received grants, honoraria, or consulting fees from, Janssen, Lundbeck, and Otsuka. Prof. G. Perugi has acted as consultant of Lundbeck, Angelini, FB-Health. He received grant/research support from Lundbeck and Angelini. He is on the speaker/advisory board of Sanofi-Aventis, Lundbeck, FB-Health, and Angelini. Pr E. Vieta has received grants and served as consultant, advisor, or CME speaker for the following entities: AB-Biotics, Abbott, Allergan, Angelini, AstraZeneca, Bristol-Myers Squibb, Dainippon Sumitomo Pharma, Farmindustria, Ferrer, Forest Research Institute, Gedeon Richter, GlaxoSmithKline, Janssen, Lundbeck, Otsuka, Pfizer, Roche, SAGE, sanofi-aventis, Servier, Shire, Sunovion, Takeda, the Brain and Behaviour Foundation, the Spanish Ministry of Science and Innovation (CIBERSAM), the EU Horizon 2020, and the Stanley Medical Research Institute. Dr G.D. Kotzalidis, Dr L. Mazzarini, Dr C. Rapinesi, Dr M. Valentí, Dr G. Anmella, Dr S. Gomes-da-Costa, Dr A. Gimenez, Dr C. Llach, and Dr N. Verdolini has been supported by a BITRECS. BITRECS project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 754550 and from “La Caixa” Foundation.
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