University of Cambridge School of Clinical Medicine, Cambridge, UK.
Psychiatr Danub. 2011 Sep;23 Suppl 1:S25-8.
Agitated Depression and Bipolar mixed states combine depressive and manic symptoms, reflecting severe forms of affective disorders with an increased suicide risk. These states have not been defined with adequate consensus and hence present a diagnostic and therapeutic challenge. In this study, we argue that both states are part of the bipolar spectrum rather than a distinct affective syndrome or a mixed anxiety-depression state.
The current literature has been reviewed and suggestions are made for a unified definition of this entity, which would be valuable in recognising this dangerous state. We have then studied 17 cases of mixed states identified from a database held by a UK community mental health team. We have studied the treatments offered and estimated the time these treatments have taken to end the mixed state and so reduce the risk of suicide.
Not surprisingly, there are no clear recommendations for treatment of these mixed states. We found that The best results were achieved with a three pronged regimen including increasing/adding mood stabilisers; and/or increasing/adding antipsychotics; as well as decreasing antidepressants. Resolution was achieved in two and a half weeks.
From this work we have deduced several general principles, which are here reviewed and hence we have been able to suggest possible treatment strategies.
Because of the close link between affective mixed states and suicidality, it is of great importance that patients be brought out of the mixed affective state as soon as possible, hence we believe that our findings are of importance in managing these patients. However we recommend further study on a larger sample in order to confirm our findings.
激越性抑郁症和双相混合状态同时存在抑郁和躁狂症状，反映出具有更高自杀风险的严重情感障碍形式。这些状态尚未得到充分共识的定义，因此构成了诊断和治疗的挑战。在这项研究中，我们认为这两种状态都是双相谱的一部分，而不是一种独特的情感综合征或混合性焦虑-抑郁状态。
回顾了当前的文献，并提出了一个统一的定义，这将有助于识别这种危险状态。然后，我们从英国社区心理健康团队的数据库中研究了 17 例混合状态病例。我们研究了提供的治疗方法，并估计了这些治疗方法结束混合状态和降低自杀风险所需的时间。
不出所料，对于这些混合状态，没有明确的治疗建议。我们发现，采用三管齐下的治疗方案效果最佳，包括增加/添加情绪稳定剂；和/或增加/添加抗精神病药；以及减少抗抑郁药。两周半后即可达到缓解。
从这项工作中，我们推导出了几个一般原则，在此进行了回顾，从而提出了可能的治疗策略。
由于情感混合状态与自杀之间的密切联系，尽快使患者摆脱混合情感状态非常重要，因此我们认为我们的发现对于管理这些患者具有重要意义。然而，我们建议在更大的样本中进行进一步研究以确认我们的发现。
