Highlights from 2024 NEI Synapse: Don’t Get Mixed Up! Recognizing and Treating Mixed Features Across the Lifespan
Saturday, April 20, 2024
The Underrecognized Challenge of Mixed Features in Mood Disorders
While categorizing patients into strict diagnostic boxes may aid clinical practice, the reality is that mood disorders exist on a spectrum. One of the most overlooked and underdiagnosed manifestations along this spectrum is depression with mixed features (DMX) - the co-occurrence of depressive and hypomanic symptoms.
In an illuminating talk, Dr. Stephen M. Stahl and Dr. Manpreet K. Singh shed light on just how prevalent mixed features are across the lifespan in both pediatric and adult populations. Despite its high prevalence, DMX often goes unrecognized by clinicians due to a lack of awareness and difficulty identifying these more subtle mixed presentations.
The failure to recognize mixed features can have profound impacts on patient wellbeing and lead to suboptimal treatment decisions. Depressive symptoms may be treated while coexisting hypomanic symptoms like irritability, distractibility, and racing thoughts are missed. This can worsen outcomes and even precipitate a mixed or manic episode in those predisposed to bipolar disorder.
To improve recognition, the speakers emphasized the need for careful symptomatic assessment, collaboration with families and interprofessional teams, and use of validated screening tools. They provided tangible examples of how to identify mixed features through clinical interview and longitudinal monitoring.
Once identified, the treatment of mixed features requires a nuanced approach. The speakers reviewed evidence-based treatment principles, such as the judicious use of atypical antipsychotics, avoiding antidepressant monotherapy, and ensuring adequate therapeutic dosing. Both pharmacological and psychotherapeutic strategies were discussed.
By raising awareness and providing practical guidance, Drs. Stahl and Singh aimed to equip clinicians to better identify and treat this underrecognized and impairing dimension of mood disorders. With improved detection and management, patients' quality of life and functioning could be dramatically improved across the diagnostic spectrum.
Source:
Stephen M. Stahl, MD, PhD, DSc (Hon.), Manpreet K. Singh, MD, MS. Don’t Get Mixed Up! Recognizing and Treating Mixed Features Across the Lifespan. Presented April 20 at 2024 NEI Synapse, Las Vegas, NV.
To Learn More: The recording of these presentations, as well as all of the other presentations from the 2024 NEI Synapse, will be available as Encore Presentations for NEI Members.