This video describes major depressive disorder with mixed features. Major depressive disorder MDD with mixed features is a disorder with a specifier. There are a number of specifiers available with MDD, and mixed features is just one of them. This is one of the more controversial specifiers we see with major depressive disorder. It's also a specifier available for bipolar disorder. This specifier is often missed and this set of symptoms is oftentimes misdiagnosed as well, because it's easy to confuse with bipolar disorder. Whenever we use a specifier with a disorder, the full criteria for the disorder have to be met first and then there are additional criteria for the specifier. In the case of mixed features there are a number of additional criteria. There are a number of different potential symptoms and an individual has to have three or more of those symptoms to qualify for the first criterion. Criterion A contains the symptom criteria. These different symptom criteria need to be present nearly every day during the majority of days of a major depressive episode. In Criterion A we see elevated or expansive mood, grandiosity or increased selfesteem, talkativeness or having pressured speech, a flight of ideas or racing thoughts, increased energy and goal directed activity, engaging in activities that have a high potential for painful consequences, and a decreased need for sleep. Criterion B notes that this behavior is observable and represents a change from the usual behavior. Criterion C indicates that if the full criteria for mania or hypomania is present then the diagnosis of bipolar disorder should be made. Again, this mixed feature specifier is often confused with bipolar disorder. Criterion D says the symptoms are not attributable to substances. There are several characteristics associated with mixed features that make it different than what we might see with other specifiers or MDD without any specifiers. We see that mixed features are a significant risk factor for developing Bipolar 1 or Bipolar II disorder. We know that oftentimes with Bipolar Disorder, an individual who has that disorder would have started with a major depressive disorder diagnosis. We also know that mixed features aren't rare. About 25 to 40% of individuals with major depressive disorder would qualify for the mixed features specifier. Oher characteristics associated with the mixed features specifier include: increased risk for suicidal behavior, increased use of substances, a poorer response to treatment, an increased number of major depressive episodes, and an earlier age of onset of major depressive disorder.