A mixed episode of bipolar disorder is a mood state in which symptoms of both mania and depression are present at the same time for at least one week. Unlike the euphoria that is sometimes associated with a pure manic episode, people in mixed states are often highly agitated, angry, and miserable. A table can provide a useful checklist that can help determine if criteria for a mixed episode are met.
What becomes apparent is that there’s quite a bit of overlap of certain symptoms of depression and mania, such as changes in sleep and concentration. Additionally, in severe episodes of mania, depression, and mixed states, psychosis (hallucinations, delusions, and thought disorganization) can be present.
As in a pure manic state, impulsive behavior, limited insight, and poor judgment are high. It is believed that 25 percent of the suicides associated with bipolar disorder occur during a mixed state.