Mixed states are very common although largely under identified. They pose a real problem for clinical characterization. Their features, in particular evolutionary, warrant special attention

The goal of the study was

1. 1) Describe the epidemiological characteristics of patients with mixed state

2. 2) To study the evolutionary and prognostic clinical aspects of mixed states

3. 3) To evaluate our clinical practice in the treatment of mixed states and to compare it with international recommendations

We achieved a retrospective descriptive cross-sectional study on 77 cases of patients with bipolar disorder. Our study was conducted between September 2004 and September 2013.

The prevalence of patients with a mixed access among admissions for bipolar disorder during the study period was 32.35%. The average age of our patients was 38.08 years, ranging from 16 to 68 years. The sex ratio was 1.26. A history of suicide attempts (TS) was found in 30 cases (39%). A substance abuse occurs in 42cas (54.5%). The average age of onset of the disease in our patients was 26 years. The average number of hospitalizations was 5.44 hospitalizations. The average total duration in days of hospitalization was 73.73 days.

Recognition of these mixed states and the use of appropriate treatment are needed to improve the prognosis and quality of life of patients