Mixed state
Main article: Mixed state (psychiatry)
In the context of bipolar disorder, a mixed state is a condition during which symptoms of mania (or hypomania) and clinical depression occur simultaneously (for example, agitation, anxiety, fatigue, guilt, impulsiveness, insomnia, disturbances appetite, irritability, morbid and/or suicidal ideation, panic, paranoia, psychosis, pressured speech, indecisiveness and rage). [5]

In at least 1/3 of persons with bipolar disorders, the entire attack--or a succession of attacks--occurs as a mixed episode.

Mixed states can be the most dangerous period of mood disorders, during which panic attacks, substance abuse, and suicide attempts increase greatly.

A dysphoric mania consists of a manic episode with depressive symptoms. Increased energy and some form of anger, from irritability to full blown rage, are the most common symptoms. Symptoms may also include auditory hallucinations, confusion, insomnia, persecutory delusions, racing thoughts, restlessness, and suicidal ideation.

Alcohol, drugs of abuse, and antidepressant drugs may trigger or aggravate dysphoric mania in susceptible individuals