Mixed affective state

In the context of mental disorder, a mixed affective state, also known as a "mixed" or "mixed-manic" episode, is a condition during which features of mania and depression—such as agitation, anxiety, fatigue, guilt, impulsiveness, irritability, morbid or suicidal ideation, panic, paranoia, pressured speech and rage—occur simultaneously or in very short succession.

In current psychiatric nomenclature, they are a defining feature of bipolar I disorder, a type of bipolar disorder wherein mania or, less commonly, mixed-mania alternate with euthymia and, in the vast majority of cases, depression.

As mentioned below, the diagnostic criteria specify that at least the minimum number of symptoms required for an independent diagnosis of both mania and depression be consistently present for at least one week (or less should psychiatric hospitalization be required); in reality, however, this criterion is rarely met, with "dysphoric mania" (up to three concurrent depressive symptoms) being much more common. Mixed affective states with a heavy preponderance of depressive symptoms may also be seen, although these may be more difficult to diagnose, as, for example, flight of ideas and "racing thoughts" may be confused for depressive rumination, and a certain tense excitation for agitation.