Which of the following best describes the 'mixed features specifier' in DSM-5 Major Depressive Disorder?
- A Presence of at least 3 manic/hypomanic symptoms during most days of the depressive episode, not meeting full criteria for mania or hypomania ✓
- B Alternating between full depressive and manic episodes within the same week
- C Psychomotor agitation with suicidal ideation during depression
- D Dysphoric mania characterised by irritability and depressive cognitions during a manic episode
Correct answer: A. Presence of at least 3 manic/hypomanic symptoms during most days of the depressive episode, not meeting full criteria for mania or hypomania
Explanation
DSM-5 allows a 'with mixed features' specifier for Major Depressive Disorder when at least 3 of the following co-occur during most days: elevated/expansive mood, inflated self-esteem/grandiosity, more talkative, flight of ideas, increased energy/goal-directed activity, increased risky behaviour, decreased need for sleep. This cannot meet full criteria for mania or hypomania (which would change the diagnosis to a bipolar disorder). Option D describes dysphoric mania, which would carry a manic episode diagnosis with mixed features specifier, not MDD.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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