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In a study of 19 manic patients, the authors found that eight suffered from mixed mania, a condition in which depressive symptoms are found in the context of classic manic features. The presence of a mixed manic state predicted at least a slower and possibly a poor response to lithium therapy. The authors suggest that the delineation of a subgroup of mixed manic patients might help to identify potential lithium-resistant patients.
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Secunda et al. (1987) studied this question.
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