Mixed episodes are associated with greater total lifetime costs, increased suicide risk, and increased substance misuse than pure manic episodes and may resemble depressive episodes due to similar quality of life scores, cognitive styles, and likelihood of cycling to depression. Patients with mixed states have an increased potential for abnormally low cholesterol, hypothyroidism, and other medical comorbidities that can slow recovery. In addition, patients with mixed states can have comorbid anxiety disorders and ADHD.
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