Incidence and Significance of Mixed Affective States in a Bipolar Population

doi:10.1001/archpsyc.1976.01770090052004

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Vol. 33 No. 9, September 1976

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Incidence and Significance of Mixed Affective States in a Bipolar Population

Jonathan M. Himmelhoch, MD; Dawood Mulla, MD; John F. Neil, MD; Thomas P. Detre, MD; David J. Kupfer, MD

Arch Gen Psychiatry. 1976;33(9):1062-1066.

Abstract

• The simultaneous existence of manic and depressive symptomsin a manic-depressive patient was first described by Kraepelin.¹This so-called mixed state has come to have much theoreticalsignificance in recent hypotheses about the nature of bipolaraffective disorders.

In this investigation a mixed state is shown to be the initialepisode in 31% of 84 manic-depressive outpatients. Moreover,the presence of "mixed" features does not correlate with severityof illness or mood circularity, but does correlate with sedativeabuse and poor response to psychopharmacologic treatment. Theseresults suggest that the "continuum hypothesis" and its satellitetheories represent viable conceptualizations of the nature ofmanic-depressive illness.

Author Affiliations

From the Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and Clinic.

Footnotes

Accepted for publication Jan 28, 1976.

Reprint requests to Department of Psychiatry, University ofPittsburgh, Western Psychiatric Institute and Clinic, 3811 O'HaraSt, Pittsburgh, PA 15261 (Dr Himmelhoch).

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