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Diagnosing and Managing Depressive Episodes in the DSM-5 Era FREE 1.0 CME CME Information CREDIT Release Date: October 1, 2015 Expiration Date: October 1, 2016

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Diagnosing and Managing Depressive Episodes in the DSM-5 Era FREE 1.0 CME CME Information CREDIT Release Date: October 1, 2015 Expiration Date: October 1, 2016 SUPPLEMENT TO Diagnosing and Managing Depressive Episodes in the DSM-5 Era FREE 1.0 CME CME Information CREDIT Release Date: October 1, 2015 Expiration Date: October 1, 2016 Estimated Time to Complete this Activity: OCTOBER 2015 / VOL 14, NO 10 1 hour Available at CurrentPsychiatry.com Overview This article provides a review of the particular challenges related to diagnosing bipolar Diagnosing and Managing and major depression disorders with mixed features and discusses the importance of accurate assessment of the mixed features Depressive Episodes qualifier in order to provide optimal treatment for patients. Moreover, the in the DSM-5 Era differences between management of bipolar disorder with mixed features and major depressive disorder with mixed features will he premise of the newly introduced mixed features specifier be addressed. in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is similar to what was proposed approximately Target Audience T This activity has been designed to meet a century ago as part of the “manic depression” unification hypothesis. the educational needs of psychiatrists and German psychiatrist Emil Kraepelin (1856–1926) originally conceptual- mental health researchers who manage ized affective states as a continuum, wherein an individual’s diagnosis patients with depressive episodes. was arrived at via a confluence of contemporaneous disturbances in mood, thought processes, and volition (behavior). His original descrip- Educational Objectives tion was agnostic insofar as it lacked the 2 categorical constructs, bipo- After participating in this educational lar disorder and major depressive disorder—terms that eventually initiative, the participant should be better appeared in the DSM. Kraepelin described a total of 6 types of mixed able to: states (depressive or anxious mania, excited depression, mania with • Integrate mechanisms for distinguishing unipolar and bipolar depression into the thought poverty, manic stupor, depression with flight of ideas, and diagnosis of patients with depressive inhibited mania) and pure depression. The phenotypic variation of symptoms, including with the mixed states that Kraepelin described (Figure 1) are similar, but not identical, features specifier to the phenotypic heterogeneity of mixed states subsumed under the • Incorporate appropriate use of current mixed features specifier in theDSM-5 .1 evidence-based treatments for depression with manic and hypomanic symptoms, Applying the mixed features specifier taking into account data that support their The definition of mixed features specifier during a major depressive use, efficacy, and safety episode would be identical in persons whose categorical diagnosis is • Translate the available evidence for the either bipolar disorder or major depressive disorder. The presence of appropriate management of the different types of depression into clinical practice the mixed features specifier during a major depressive episode in an adult with major depressive disorder heuristically bridges bipolar dis- Faculty order and major depressive disorder and is a tacit endorsement of an Roger S. McIntyre, MD, FRCPC affective continuum (Figure 2).2-4 The mixed features specifier inDSM-5 Professor of Psychiatry and Pharmacology supplants the previous diagnosis of mixed states, which was defined as University of Toronto the syndromal presence of a manic and depressive episode.3 The speci- Head, Mood Disorders fier “with mixed features” can be applied to an episode of hypoma- Psychopharmacology Unit nia/mania if 3 or more prespecified depressive features are present, as University Health Network well as a major depressive episode if 3 or more prespecified hypomanic Toronto, ON, Canada features are present.3 Figure 2 presents and juxtaposes the conceptual CONTINUED ON PAGE S2 framework of DSM-IV-TR and DSM-5. As can be seen in the figure, for a diagnosis of mania with mixed features, at least 3 core manic symp- toms and at least 3 core depressive symptoms need to be present. For a diagnosis of depression with mixed features, at least 3 core manic symptoms and at least 5 depressive symptoms need to be present.3 Several core and nonoverlapping symptoms exist in depression with mixed features. Symptoms that are core (ie, allowed) include diminished interest or pleasure, slowed physical and emotional reac- CONTINUED ON PAGE S3 Supplement to Current Psychiatry | Vol 14, No 10 | October 2015 S1 DIAGNOSING AND MANAGING DEPRESSIVE EPISODES IN THE DSM-5 ERA CONTINUED FROM PAGE S1 Statement of Support life partner have with commercial interests related to the This activity is jointly provided by RMEI, LLC and Postgraduate content of this CME activity: Institute for Medicine. This activity is supported by an Roger S. McIntyre, MD, FRCPC independent educational grant from Sunovion. 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