James Holmes, the 24-year-old former neuroscience graduate student who's been charged in the gruesome movie theater shooting in Aurora, Colo., last month, had asked a fellow graduate student about a mental condition called dysphoric mania weeks before the shooting, the New York Times reported.
According to the Times report:
She messaged back, asking him if dysphoric mania could be managed with treatment. Mr. Holmes replied: "It was," but added that she should stay away from him "because I am bad news." It was the last she heard from him.
The detailed Times report did not say whether this condition is something that Holmes had officially been diagnosed with, or what kinds of treatment he was receiving for this condition if he did, indeed, have it.
But Dr. Alan C. Swann, who has conducted research on the condition, told HuffPost that dysphoric mania -- also known as mixed mania -- can be harder to treat and diagnose than if someone experiences the more well-known symptoms of bipolar disorder.
Most people know that bipolar disorder involves mood swings from depression to mania. But "it's not always that well compartmentalized, not for everybody," explains Swann, who is the director of research at the University of Texas Harris County Psychiatric Center and professor and vice-chairman of research of the Department of Psychiatry and Behavioral Sciences at The University of Texas Health Science Center at Houston.
With dysphoric mania, a person may be in a manic phase, but that mania is tinged with dark, negative emotions, explains Swann, who is not involved in Holmes' treatment. A person can feel depressed and hopeless, but they can be activated and have energy at the same time. This could also put them at a higher risk for self harm and suicide, he says.
According to a 2000 study in the journal Comprehensive Psychiatry that examined the characteristics of mixed mania compared with depression and mania, Italian researchers said that "patients with depression more frequently reported a history of suicidality than those with mania, whereas they did not significantly differ from patients with mixed mania."
However, "it's not like people should be afraid of people in mixed states," Swann tells HuffPost. "It's a severe form of illness. It just means they have a more severe illness to overcome."
If a doctor knows to look out for this mixed state of mania and depression, it's not difficult to diagnose dysphoric mania. But the tricky part is exactly that -- knowing to look for these combined symptoms. "The problem is it goes against what you learn in school. When someone is depressed, they [the doctors] have to look for some subtle sides of the opposite," Swann says. "If someone's manic, you have to look for the opposite of mania -- helpless, anxious, worried … It can be hard to see."
Right now, mixed mania is listed under bipolar disorder in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). However, in the upcoming DSM-V, there is a proposed revision to define bipolar disorder with mixed features as either being "predominantly manic or hypomanic," coupled with three symptoms of depression (like fatigue, feelings of worthlessness, etc.) or as being "predominantly depressed," coupled with three symptoms of mania (like elevated mood, extreme talkativeness, more energy, etc.).
WebMD reported that mixed episodes of depression and mania affect anywhere from 20 to 70 percent of people with bipolar disorder. It's more difficult to treat with antipsychotic or mood-stabilizing medications -- "it generally takes more time and medicine to get well," Swann says -- since certain mood-stabilizing drugs like lithium that are typically used for bipolar may not work quite as well for dysphoric mania.
And if a doctor doesn't catch the signs of mania and only treats the signs of depression with antidepressants, it could actually exacerbate the mania, Swann says, as "antidepressants often backfire in bipolar disorder because they can make someone who's depressed and activate them."