Bipolar Disorder - Mixed States: A Diagnostic Dilemma (Part-I).

There is a large difference in classifying Mixed States according to the prevailing standardized classifications because of the differential focus of the various criteria in identifying Mixed States. Aims: To assign the Mania With Depressive symptoms patients in different groups and to compare the phenomenology, personality profiles and psychiatric co-morbidities of these various groups so generated. Material and Methods: 64 patients were randomly selected from the 214 Bipolar Disorder – Current episode Manic (as per DSM IV TR9) patients admitted in Psychiatry ward of P.B.M. General Hospital,Bikaner from 1st Jan 2007 to 31st Dec. 2007. After recording socio-demographic data on a self-designed Performa, Young’s Mania Rating Scale (YMRS)and Montgomery Asberg Depression Rating Scale (MADRS) were administered on day 1,3,5,7 and 9 till discharge.32 patients were assigned to Mania with Depressive Symptoms on displaying 1 or more depressive symptom, excluding decreased sleep.32 patients were assigned to Pure Mania group who displayed no Depressive symptoms. Results: 30 patients(94%) could be assigned to Mixed states according to Vienna Criteria,25(78%) could reach the diagnosis of Mixed States as per Cincinnati criteria, another 17(53%) were assigned to Mixed States as per Pisa San Diego Criteria.ICD-10 could identify 5 patients(16%) and DSM IV TR appeared to identify the least that is 3 patients(9%) Conclusion: Concept of MS couldn’t be better explained with these existing criteria because some patients meeting one criterion are not meeting others.