In DSM-5, which of the following correctly describes a Mixed Features specifier in Major Depressive Episode?
- A At least 3 manic/hypomanic symptoms present during most of the depressive episode, not meeting full criteria for mania ✓
- B Full criteria for both major depression and mania met simultaneously
- C Depressive episode with irritable mood as the predominant feature
- D Depression with psychomotor agitation and racing thoughts only
Correct answer: A. At least 3 manic/hypomanic symptoms present during most of the depressive episode, not meeting full criteria for mania
Explanation
The DSM-5 Mixed Features specifier (applicable to both MDD and bipolar disorder) requires at least 3 manic or hypomanic symptoms (elevated/expansive mood, inflated self-esteem, more talkative, flight of ideas, decreased need for sleep, increased goal-directed activity, excessive pleasurable activities) present during most days of a depressive episode, but not meeting full criteria for mania/hypomania. Irritability and psychomotor agitation alone do not qualify as mixed features as they overlap with depressive criteria. This replaces the DSM-IV 'Mixed Episode' concept.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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