In the beginning before I was diagnosed with Bipolar Type I, my psychiatrist and psychologist couldn't agree on how to classify my symptoms. I actually thought I was schizophrenic, despite my deeply rooted fear of the word. I was extremely afraid that I was right. I didn't want to be schizophrenic, but what other explanation was there? There was also the possibility of what I was experiencing being a mixed episode and Bipolar Disorder could be the diagnosis.

My psychiatrist said to me, "You are not schizophrenic, and you certainly don't have Mixed Episodes." He dismissed two possibilities out of hand.

But my days were filled with nervous energy, suicidal thoughts, racing thoughts, confused speech, and auditory hallucinations which were, thankfully, infrequent. At night I didn't sleep much, and when I did it was a fitful and not at all restful. 

I had yet to be diagnosed with anything, but there was certainly something wrong. My work performance suffered greatly and I was having problems in my relationships with others. I needed treatment (and a diagnosis). To confuse matters, I had obvious Obsessive Compulsive Disorder (OCD) symptoms with checking rituals and anxiety.

My doctors agreed OCD was a problem, and we began treatment for that with Prozac (20mg immediately with a target dose of 80 or 100mg). This would have been appropriate but for the question of Bipolar Disorder. Using Prozac alone, especially in high doses, could trigger mania.

My psychologist said that I was in the middle of a mixed episode and that I should have a diagnosis of Bipolar Type I. It took quite a bit of discussion, and it wasn't until I came out of the mixed episode about a week later that my psychiatrist agreed with my psychologist and initial paper and pencil testing about the diagnosis of Bipolar.

The doctor had been saying all along that Mixed Episodes are rare. He was right, but that didn't mean I didn't have them in my repertoire.  

There are strict criteria for diagnosing a Mixed Episode. It must cover a period of at least a week in which symptoms of both mania and major depression are present. They must also cause difficulties in the ability to function: decreased work performance, problems in relationships, etc. Mixed Episodes may sometimes require hospitalization for treatment.

In most cases, the psychiatrist would have been right. Few Bipolar individuals have mixed episodes, and no one with Bipolar Type II has them, by definition. But with me it was the identification of this state that led to my correct diagnosis. Most people are only diagnosed with Bipolar Disorder after a long time of trial and error putting the pieces together. I was lucky to have that particular psychologist on the case. We altered what medicines I needed, and things were on the right track.