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Analysis of institutional authors

Solé EAuthorSole, EvaAuthorGarriga, MarinaAuthorValenti, MarcAuthorVieta, EduardCorresponding Author

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January 23, 2025
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Mixed features in bipolar disorder

Publicated to: Cns Spectrums. 22 (2): 134-140 - 2017-04-01 22(2), DOI: 10.1017/S1092852916000869

Authors:

Sole, Eva; Garriga, Marina; Valenti, Marc; Vieta, Eduard
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Affiliations

Univ Barcelona, Inst Neurosci, Hosp Clin, Bipolar Disorder Unit, Barcelona, Spain - Author

Abstract

Mixed affective states, defined as the coexistence of depressive and manic symptoms, are complex presentations of manic-depressive illness that represent a challenge for clinicians at the levels of diagnosis, classification, and pharmacological treatment. The evidence shows that patients with bipolar disorder who have manic/hypomanic or depressive episodes with mixed features tend to have a more severe form of bipolar disorder along with a worse course of illness and higher rates of comorbid conditions than those with non-mixed presentations. In the updated Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), the definition of "mixed episode" has been removed, and subthreshold nonoverlapping symptoms of the opposite pole are captured using a "with mixed features" specifier applied to manic, hypomanic, and major depressive episodes. However, the list of symptoms proposed in the DSM-5 specifier has been widely criticized, because it includes typical manic symptoms (such as elevated mood and grandiosity) that are rare among patients with mixed depression, while excluding symptoms (such as irritability, psychomotor agitation, and distractibility) that are frequently reported in these patients. With the new classification, mixed depressive episodes are three times more common in bipolar II compared with unipolar depression, which partly contributes to the increased risk of suicide observed in bipolar depression compared to unipolar depression. Therefore, a specific diagnostic category would imply an increased diagnostic sensitivity, would help to foster early identification of symptoms and ensure specific treatment, as well as play a role in suicide prevention in this population.
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Keywords

bipolar disorderdepressiondsm–5mixed statesBipolar disorderClassificationCohortComorbiditieComorbidityDepressionDepressive disorder, majorDepressive episodeDiagnosisDiagnosis, differentialDiagnostic and statistical manual of mental disordersDsm-5Dsm–5HumansKey words mixed statesManic symptomsMixed statesPhenomenologyPrevalencePrognosisRisk factorsStatesSuicidSuicidal ideationSuicideSuicide attempts

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal CNS SPECTRUMS due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2017, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Psychiatry and Mental Health.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.63. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2026-04-05, the following number of citations:

  • WoS: 46
  • Scopus: 26
  • Europe PMC: 33
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Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-05:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 122.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 122 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 13.
  • The number of mentions on the social network X (formerly Twitter): 1 (Altmetric).
  • The number of mentions on Wikipedia: 1 (Altmetric).
  • The number of mentions in news outlets: 1 (Altmetric).
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Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Solé Roigé, Eva) and Last Author (Vieta Pascual, Eduard).

the author responsible for correspondence tasks has been Vieta Pascual, Eduard.

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Awards linked to the item

The authors are grateful for the support of CIBERSAM, the Spanish Ministry of Economy and Competitiveness (PI 12/00910); the Plan Nacional de I + D + I y cofinanciado por el ISCIII Subdireccion General de Evaluacion y el Fondo Europeo de Desarrollo Regional; and the Comissionat per a Universitats i Recerca del DIUE de la Generalitat de Catalunya for the Bipolar Disorders Group (2014 SGR 398).
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