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Abstract
The purpose of this paper is to review the evolution of the concept, prevalence, clinical correlates, and current evidence for biological treatments of bipolar mixed states, emphasize the illness complexities of bipolar mixed states while highlighting the gaps in clinical treatment and research using International Classification of Diseases, tenth edition (ICD-10) criteria. Narrowly defined ICD-10 mixed episodes ignores subthreshold symptoms of the opposite pole common with patients. Further clinical studies specifically designed to enroll the full range of mixed states are needed to promote appropriate treatment options and improve clinical outcomes.
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