It has been recognized that the DSM-IV-TR criteria for mixed episode
did not reflect the most common phenomenology of patients with bipolar depression and admixture of hypomania.
Concerning mood disorders, the depressive episode was more prevalent in 10% of the individuals interviewed, followed by mixed episode
However, differential diagnosis becomes much more challenging when evaluating the possibility of rapid-cycling bipolar disorder or a mixed episode
The Food and Drug Administration has approved risperidone for the treatment of schizophrenia in adolescents aged 13-17 years and for the short-term treatment of bipolar mania associated with manic or mixed episodes
of bipolar I disorder in children and adolescents aged 10-17 years, after years of off-label use by many physicians.
In the bipolar I form, the individual experiences one or more manic episodes, or mixed episodes
and possibly one or more major depressive episodes.
In a study of 71 adolescents with BD followed for 1 year after their first hospitalization for a manic or mixed episode
, DelBello et al11 defined nonadherence as taking medication < 25% of the time and partial adherence as taking medication 25% to 75% of the time.
A manic episode was observed in 23% of patients, and a mixed episode
was observed in 22%.
This randomized, double-blind, placebo-controlled study enrolled adult patients meeting DSM-IV criteria for Bipolar I Disorder, who experienced a recent manic or mixed episode
and who had a history of one or more manic or mixed episodes
of sufficient severity to require hospitalization and/or treatment with a mood stabilizer or antipsychotic.
The 153 outpatients age 7 to 17 in a bipolar I manic or mixed episode
were randomly assigned to lithium, divalproex, or placebo for 8 weeks.
Patients having a mixed episode
of bipolar disorder meet the criteria for both a manic episode and a major depressive episode nearly every day for at least 1 week.
The efficacy of risperidone in the treatment of manic or mixed episodes
in children or adolescents with bipolar I disorder was demonstrated in a three-week, randomized, double-blind, placebo-controlled, trial involving 160 patients who were experiencing a manic or mixed episode
Patients with acute bipolar mania or a mixed episode
were treated with olanzapine or placebo for 4 weeks in a randomized, double-blind trial.