So far we've talked
we've talked about mania,
we've talked about hypomania.
But everything is not
always so black and white.
Sometimes we might find that
someone is coming into the hospital
and has a diagnosis
of mania or hypomania
and has fit all
of that criteria.
But there are some other features
to this person's diagnosis,
features that we don't
typically think of
when we think of a person
who has a diagnosis of mania.
So I want you to think of this SIG E
CAPS as just a way of thinking about
other possible criteria or
symptoms that we might see
in a person who has
mania or hypomania.
And if the person demonstrates even 3
of these different SIG E CAPS symptoms,
we want to start thinking that
perhaps this is mixed features.
They still have
mania or hypomania.
But now we're going
to say there are some
other features mixed
in with that diagnosis
that are not what we
So although with mania, we think
they're going to be awake all the time.
If we have a manic patient who comes
in and we see these sleep changes
where they are sleeping
more during the day,
maybe less during the night,
but sleeping during the day,
or if they have loss of
interest in their activities,
which we would really be thinking
depression at that point.
If we have 3 of these,
guilt, lack of energy,
their concentration being
reduced, their weight changing,
they have some of their psychomotor
retardation along with the agitation
or maybe they have some suicidal
thoughts and hopelessness
and or homicidal ideation, then we're
going to think that this person,
although they meet all the
criteria for mania or hypomania
have mixed features,
they have some depressive features
that are also in this mix.
Again, if you've have anyone
who is suicidal or homicidal,
as a nurse,
you have a duty to warn.
It is important to make sure that
that person gets immediate help
and that if they are threatening the life
of another that that person is warned.
So just as we said with mania hypomania,
it's not always black and white.
Sometimes people come in
and they have depression.
And that depression meets full criteria
for the diagnosis of depression.
But they have 3 different symptoms at
least from the next list that I give you,
which we'll call
the DIG FAST issue.
We don't expect a person with depression
to have this increased distractibility.
We don't expect them to have this
irresponsibility or uninhibited behaviors.
We don't expect them
to have grandiosity.
If they do have these symptoms
during their depression,
if they have flight of ideas,
if they are showing that they have
anxiety, weight loss,
that they have this
decrease in sleep or
increase in talkativeness.
All symptoms and signs that we
associate with mania or hypomania
and they actually fit
the depressive criteria.
We would say, this is a person with
depression with mixed features.
It's not a clear cut thing.
Human beings are
It is a little bit of
everything in there.
So what do we do
for people who have
bipolar 1, bipolar 2,
or depression with
or mania with mixed features?