ReviewCNS drugs2015
Diagnosis, Epidemiology and Management of Mixed States in Bipolar Disorder.
Review in CNS drugs, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 76 citations in OpenAlex.
- The Complex Pattern Mismatch Negativity as a Potential Indicator of Psychosis Across all Phases of Illness: A Meta-Analysis.Clinical EEG and neuroscience · 2025Pooled it
- Effects on health-related quality of life in patients treated with lurasidone for bipolar depression: results from two placebo controlled bipolar depression trials.BMC psychiatry · 2016Trial
- Real-world outcomes of lurasidone augmentation for treatment-resistant bipolar depression: a retrospective observational analysis.Frontiers in psychiatry · 2026Article
- Automated Monitoring and Clinical Notifications of Patient State for Neuropsychiatric Neuromodulation Studies.Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference · 2025Article
- Antidepressants in Bipolar Depression: From Neurotransmitter Mechanisms to Clinical Challenges.Actas espanolas de psiquiatria · 2025Review
- Bipolar disorder at mixed states and major depressive disorder with mixed features differ in peripheral biochemical parameters.BMC psychiatry · 2025Observational
- Multiple-timescale dynamics, mixed mode oscillations and mixed affective states in a model of bipolar disorder.Cognitive neurodynamics · 2024Article
- Enhancing Transcriptomic Insights into Neurological Disorders Through the Comparative Analysis of Shapley Values.Current issues in molecular biology · 2024Article
- Insights into the Incidence, Course, and Management of Lithium-Induced Hypothyroidism in Real-World Psychiatric Practice in Italy.Pharmaceuticals (Basel, Switzerland) · 2024Article
- The Relationship of Functioning and Life Satisfaction with Illness Management and Recovery in Patients with Bipolar Disorder: A Cross-Sectional Study.Community mental health journal · 2024Article
- The Epidemiological, Clinical, and Therapeutic Profile of Bipolar Patients in Eastern Morocco.Cureus · 2024Article
- Plasma IGFBP-3 and IGFBP-5 levels are decreased during acute manic episodes in bipolar disorder patients.Frontiers in pharmacology · 2024Article
- Optimizing multi-domain hematologic biomarkers and clinical features for the differential diagnosis of unipolar depression and bipolar depression.Npj mental health research · 2023Article
- Case report: Rapid symptom resolution of a mixed affective state with high-frequency repetitive transcranial magnetic stimulation.Frontiers in psychiatry · 2023Article
- A missing link in affect regulation: the cerebellum.Social cognitive and affective neuroscience · 2022Review
- Reliability and validity of clinically useful depression outcome scale identifying mixed features in patients with manic episode.Brain and behavior · 2021Article
- Clozapine: Why Is It So Uniquely Effective in the Treatment of a Range of Neuropsychiatric Disorders?Biomolecules · 2021Review
- The Neurometabolic Basis of Mood Instability: The Parvalbumin Interneuron Link-A Systematic Review and Meta-Analysis.Frontiers in pharmacology · 2021Review
- Treatment of Symptom Clusters in Schizophrenia, Bipolar Disorder and Major Depressive Disorder With the Dopamine D3/D2 Preferring Partial Agonist Cariprazine.Frontiers in psychiatry · 2021Review
- Efficacy, Safety, and Tolerability of Theta-Burst Stimulation in Mixed Depression: Design, Rationale, and Objectives of a Randomized, Double-Blinded, Sham-Controlled Trial.Frontiers in psychiatry · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Approximately 40% of patients with bipolar disorder experience mixed episodes, defined as a manic state with depressive features, or manic symptoms in a patient with bipolar depression. Compared with bipolar patients without mixed features, patients with bipolar mixed states generally have more severe symptomatology, more lifetime episodes of illness, worse clinical outcomes and higher rates of comorbidities, and thus present a significant clinical challenge. Most clinical trials have investigated second-generation neuroleptic monotherapy, monotherapy with anticonvulsants or lithium, combination therapy, and electroconvulsive therapy (ECT). Neuroleptic drugs are often used alone or in combination with anticonvulsants or lithium for preventive treatment, and ECT is an effective treatment for mixed manic episodes in situations where medication fails or cannot be used. Common antidepressants have been shown to worsen mania symptoms during mixed episodes without necessarily improving depressive symptoms; thus, they are not recommended during mixed episodes. A greater understanding of pathophysiological processes in bipolar disorder is now required to provide a more accurate diagnosis and new personalised treatment approaches. Targeted, specific treatments developed through a greater understanding of bipolar disorder pathophysiology, capable of affecting the underlying disease processes, could well prove to be more effective, faster acting, and better tolerated than existing therapies, therefore providing better outcomes for individuals affected by bipolar disorder. Until such time as targeted agents are available, second-generation neuroleptics are emerging as the treatment of choice in the management of mixed states in bipolar disorder.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.