Dysphoric or mixed- lt is severe type, and difficult to treat. A review of studies revealed associations with suicidality, an earlier age of onset, their episode is longer duration, and higher rates of personal and family depression, higher concomitant alcohol or sedative- hypnotic abuse, more neuropsychiatric abnormalitics, their poorer outcome Patients in acute episodes of mixed mania respond better to valproate than lithium. Most atypical antipsychotics have an indication, too, for mixed mania, though combinations are often needed.