Editing Bipolar disorder (section)

=== Mixed affective episodes ===
{{Main|Mixed affective state}}

In bipolar disorder, a [[Mixed affective state|mixed state]] is an episode during which symptoms of both mania and depression occur simultaneously.<ref name="Swann2013">{{cite journal |vauthors=Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk WM, Scott J, Ha K, [[Trisha Suppes|Suppes T]] | title = Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis | journal = Am J Psychiatry | volume = 170 | issue = 1 | pages = 31–42 | date = January 2013 | pmid = 23223893 | doi = 10.1176/appi.ajp.2012.12030301 }}</ref> Individuals experiencing a mixed state may have manic symptoms such as grandiose thoughts while simultaneously experiencing depressive symptoms such as excessive guilt or feeling suicidal.<ref name="Swann2013" /> They are considered to have a higher risk for suicidal behavior as depressive emotions such as hopelessness are often paired with [[Emotional lability|mood swings]] or [[Impulsivity|difficulties with impulse control]].<ref name="Swann2013" /> [[Anxiety disorder]]s occur more frequently as a comorbidity in mixed bipolar episodes than in non-mixed bipolar depression or mania.<ref name="Swann2013" /> Substance (including [[Alcohol use disorder|alcohol]]) use also follows this trend, thereby appearing to depict bipolar symptoms as no more than a consequence of substance use.<ref name="Swann2013" />