Bipolar mixed features – Results from the comparative effectiveness for bipolar disorder (Bipolar CHOICE) study

Mauricio Tohen, Alexandra K. Gold, Louisa G. Sylvia, Rebecca E. Montana, Susan L. McElroy, Michael E. Thase, Dustin J. Rabideau, Andrew A. Nierenberg, Noreen A. Reilly-Harrington, Edward S. Friedman, Richard C. Shelton, Charles L. Bowden, Vivek Singh, Thilo Deckersbach, Terence A. Ketter, Joseph R. Calabrese, William V. Bobo, Melvin G. McInnis

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background DSM-5 changed the criteria from DSM-IV for mixed features in mood disorder episodes to include non-overlapping symptoms of depression and hypomania/mania. It is unknown if, by changing these criteria, the same group would qualify for mixed features. We assessed how those meeting DSM-5 criteria for mixed features compare to those meeting DSM-IV criteria. Methods We analyzed data from 482 adult bipolar patients in Bipolar CHOICE, a randomized comparative effectiveness trial. Bipolar diagnoses were confirmed through the MINI International Neuropsychiatric Interview (MINI). Presence and severity of mood symptoms were collected with the Bipolar Inventory of Symptoms Scale (BISS) and linked to DSM-5 and DSM-IV mixed features criteria. Baseline demographics and clinical variables were compared between mood episode groups using ANOVA for continuous variables and chi-square tests for categorical variables. Results At baseline, the frequency of DSM-IV mixed episodes diagnoses obtained with the MINI was 17% and with the BISS was 20%. Using DSM-5 criteria, 9% of participants met criteria for hypomania/mania with mixed features and 12% met criteria for a depressive episode with mixed features. Symptom severity was also associated with increased mixed features with a high rate of mixed features in patients with mania/hypomania (63.8%) relative to those with depression (8.0%). Limitations Data on mixed features were collected at baseline only and thus do not reflect potential patterns in mixed features within this sample across the study duration. Conclusions The DSM-5 narrower, non-overlapping definition of mixed episodes resulted in fewer patients who met mixed criteria compared to DSM-IV.

Original languageEnglish (US)
Pages (from-to)183-189
Number of pages7
JournalJournal of Affective Disorders
StatePublished - Aug 1 2017


  • Bipolar disorder
  • DSM-5
  • DSM-IV
  • Mixed features

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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