Mixed states or dysphoric manias can be defined in broad terms as a state in which coexist simultaneously depressive and manic symptoms (mixed state), also known as agitated depression or a mixed episode. Were first described by Emil Kraepelin in his psychiatry treaty.
Conditions referred to a mixed mania or dysphoric mania, are characterized by dysphorically excited moods, irritability, anger, panic attacks pressured speech, agitation, suicidal ideation, severe insomnia, grandiosity and hypersexuality, as well as persecutory delusions and confusion.
The most severe phase of mania is characterized by the appearance of incongruent psychotic symptoms, disorganized behavior, irritability and depressive symptoms. Mixed states are the most dangerous period of mood disorders and in extreme situations may lead to suicide attempts and substance abuse.
There are some difficulties in the diagnosis of these conditions since the coexistence of manic depressive symptoms may have the appearance of neurotic symptoms.
Momentary tearfulness and even depressed mood are commonly observed at the height of mania or during the transaction from mania to retarded depression. These transient instable periods, which occur in most bipolar disorder patients, must be contrasted with mixed episodes proper.
Dysphoric mania is a very complex state of psychopathology and particularly serious, with the coexistence of manic and depressive symptoms, representing about a third of all "mania" with higher prevalence in women.
Due to the complexity of its clinical presentation, is still in question whether they are transition states of mania to depression or vice versa. A correct diagnosis helps to avoid conventional antipsychotic drugs known to exacerbate the depressive component; in such patients, failure to use mood stabilizers can prolong the patient’s misery.