The new DSM doesn't use the term "mixed state." Instead, it names that state mania or depression and adds "with mixed features." This seems to complicate the situation further, so I'll continue to use the term "mixed state" or "mixed episode."
I think I have spent a great portion of my illness in a mixed state. Maybe all I want to do is sleep, but I'm also bursting with everything I need to say. I might hate myself and have furious, ecstatic hypergraphia. I might believe I'm brilliant and capable of anything, yet I'm paranoid that I'm going to lose everything, which leaves me a weepy mess. I might be on fire with new ideas yet too miserable to speak.
A mixed state is like being in total darkness while the very air issues thousands of tiny, stinging shocks.
It's like standing at the edge of a tar moat that is somehow so smooth that it looks like glass. So I try to step onto that black ice, and I sink. Calling for help doesn't help. Swimming doesn't work. And the sun is blinding.
Mixed episodes may be most dangerous because depression gives one hopelessness, and mania gives one the energy (and, for lack of a better word, creativity) to self-destruct.
I wish I had some advice. But recognizing a mixed episode may help both the person and his or her caregivers. Empathy is first.
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