DSM-5 introduced a new specifier 'with mixed features' for major depressive episodes. Which combination of symptoms qualifies a depressive episode for this specifier?

• A Concurrent full manic episode lasting at least 1 week
• B Three or more manic/hypomanic symptoms (elevated/expansive mood, decreased sleep, grandiosity, pressured speech, flight of ideas, increased goal-directed activity, reckless behaviour) present nearly every day ✓
• C Any two hypomanic symptoms on at least 3 days during the episode
• D Rapid cycling pattern (≥4 episodes/year) within the depressive episode

Explanation

The DSM-5 'with mixed features' specifier for a major depressive episode requires ≥3 of the following manic/hypomanic symptoms present nearly every day: elevated or expansive mood, inflated self-esteem or grandiosity, more talkative or pressured speech, flight of ideas, decreased need for sleep (not insomnia), increased goal-directed activity, and involvement in pleasurable activities with high risk — without meeting the full criteria for a manic/hypomanic episode. This specifier replaces the old DSM-IV 'mixed episode' concept and is applicable to both bipolar and unipolar depression.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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