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What if a patient includes depressive symptoms in the description of their anchor point for mania (most extreme manic state)?

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What if a patient includes depressive symptoms in the description of their anchor point for mania (most extreme manic state)?

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Patients often describe a mixed episode as their most extreme manic state and thus include depressive symptoms such as suicidal thoughts. The patient identifies the hyperactivity, increased drive, racing thoughts as mania even when accompanied by depressed or irritable mood. Patients who have experienced both a manic and a mixed episode will invariably describe the mixed episode, typified by agitation, insomnia, and suicidal thinking, as the extreme anchor point for mania. Patients who experience a mixed mood of irritable mania and depression will generally enter a data point for mood in the manic range along with decreased hours of sleep.

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