Which specifier would be used if mood symptoms include both manic and depressive criteria during the same episode?

• A. With rapid cycling
• B. With peripartum onset
• C. With catatonia
• D. With mixed features

Answer: (D)

When a mood episode contains symptoms from both poles—manic/hypomanic and depressive—within the same period, the appropriate specifier is mixed features. This label captures the overlap of opposite mood symptoms in one episode, such that during a manic or hypomanic phase there are depressive symptoms present (and vice versa, during a depressive episode there are manic symptoms). Clinically, this often means at least a subset of symptoms from the opposite pole is present for most of the episode, commonly around three symptoms, signaling a blend rather than a clean, single-pole episode.

This is distinct from rapid cycling, which refers to having four or more mood episodes within a year; peripartum onset, which points to onset around childbirth; and catatonia, which involves motor and behavioral symptoms that can accompany mood disorders. Recognizing mixed features helps in prognosis and guiding treatment, since the overlap can indicate greater mood instability and influences how therapies are chosen.