Psychiatric specifier

With mixed features

Clinically meaningful symptoms of the opposite mood pole occur during the predominant mood episode.

Episode features

Depressive disordersBipolar disorders

At a glance

Applies to: Depressive disorders · Bipolar disorders
Deciding signal: The presentation crosses mood poles rather than being explained by anxiety, irritability, or agitation alone.
Ask this: Are there distinct opposite-pole symptoms during this episode that change diagnostic and treatment reasoning?
Wording outcome: Major depressive disorder, current episode, with mixed features

The only cross-over features are irritability, distractibility, insomnia, or nonspecific agitation.
Activation is better explained by substances, medication, trauma arousal, ADHD, or another condition.

Fit and exclusions

Start with the deciding signal, then test chronology, competing explanations, and the effect on diagnostic wording.

Opposite-pole symptoms are observable, recurrent, and tied to the current episode.
Activation includes features such as elevated drive, reduced need for sleep, or accelerated thought and speech.
The pattern changes the assessment of bipolarity and antidepressant-related risk.

Treat as a cross-polar signal: reassess medication strategy, activation risk, and longitudinal bipolar history.

Major depressive disorder, current episode, with mixed features

At a glance

Applies to

Depressive disorders · Bipolar disorders

Deciding signal

The presentation crosses mood poles rather than being explained by anxiety, irritability, or agitation alone.

Ask this

Are there distinct opposite-pole symptoms during this episode that change diagnostic and treatment reasoning?

Wording outcome

Major depressive disorder, current episode, with mixed features