Which specifier indicates the presence of both manic and depressive symptoms?

• A. With rapid cycling
• B. With melancholic features
• C. With atypical features
• D. With mixed features

Answer: (D)

The key idea is recognizing a specifier that signals both poles of mood symptoms within the same episode. “With mixed features” is used when manic or hypomanic symptoms occur alongside depressive symptoms during the same episode. In other words, you have the energy, grandiosity, and activity of mania plus depressive symptoms such as sadness, sleep disturbance, or hopelessness present most days of that episode. This combination matters because it changes risk and treatment considerations, and it’s distinct from patterns like rapid cycling (frequency of episodes), melancholic features (a specific severe depression pattern), or atypical features (mitness of mood reactivity with specific vegetative symptoms). So the correct specifier is “with mixed features.”