Australian & New Zealand Journal of Psychiatry | 2021
Managing mixed mood states by maintaining a maintenance mindset?
Abstract
The management of mixed mood states is difficult for several reasons. First, mixed states are poorly and variably defined, with Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) failing to capture clinical reality (Sani and Swann, 2020). Second, because mixed states have been under-recognised, research informing management is extremely modest as compared to other acute presentations (mania and bipolar depression). And third, the management of mixed states is inherently complex because it entails treating diverse symptoms across separate dimensions (Cuomo et al., 2020). Recent guidelines for the management of mood disorders are among the first to provide specific advice for the management of acute mixed presentations; details can be found both in the comprehensive document (Malhi et al., 2021) and a recently published summary (Malhi et al., 2020). In this editorial, drawing on the similarities and differences between maintenance therapy and acute mixed presentations, we discuss the principles of management with a view to providing a framework for navigating these complex presentations.