Clinical and legal characteristics of inmates with bipolar disorder
Department of Psychiatry and Behavioral Sciences, Division of Psychiatry and the Law, University of California, Davis, 2230 Stockton Boulevard, Sacramento, CA 95817, USA.Current Psychiatry Reports (Impact Factor: 3.24). 01/2006; 7(6):478-84. DOI: 10.1007/s11920-005-0070-z
Individuals with bipolar disorder are at an increased risk of criminal arrest compared with those in the population at large. The combination of manic symptoms and substance abuse seem to be the primary illness factors for this increased risk, and the public mental health system has faced challenges in treating these patients successfully in community settings. To decrease the risk for arrest in bipolar patients, clinicians can screen and refer patients for substance use disorders, stabilize mania in hospital settings, and take measures to improve outpatient adherence in the postmanic hospitalization period. Psychiatric advance directives, new developments in civil commitment law, and mental health courts are legal mechanisms that may be critical in preventing the criminalization of those with bipolar disorder.
Article: Bipolar disorder[Show abstract] [Hide abstract]
ABSTRACT: Bipolar disorder is a pathological disturbance of mood, characterized by waxing and waning manic, depressive and, sometimes distinctly mixed states. A diagnosis of bipolar disorder can only be made with certainty when the manic syndrome declares itself. Most individuals who are diagnosed with this disorder will experience both poles of the illness recurrently, but depressive episodes are the commonest cause of morbidity and, indeed, of death by suicide. Twin, adoption and epidemiological studies suggest a strongly genetic aetiology. It is a genetically and phenotypically complex disorder. Thus, the genes contributing are likely to be numerous and of small effect. Individuals with bipolar disorder also display deficits on a range of neuropsychological tasks in both the acute and euthymic phases of illness and correlations between number of affective episodes experienced and task performance are commonly reported. Current self-report and observer-rated scales are optimized for unipolar depression and hence limited in their ability to accurately assess bipolar depression. The development of a specific depression rating scale will improve the assessment of bipolar depression in both research and clinical settings. It will improve the development of better treatments and interventions. Guidelines support the use of antidepressants for bipolar depression. With regard to the adverse effects of antidepressants for bipolar depression, double-blind, placebo-controlled data suggest that antidepressant monotherapy or the addition of a tricyclic antidepressant may worsen the course of bipolar disorder. Importantly, adjunctive psychotherapies add significantly (both statistically and clinically) to the efficacy of pharmacological treatment regimens. The successful management of bipolar disorder clearly demands improved recognition of bipolar disorder and effective long-term treatment for bipolar depression as well as mania.Progress in Neuro-Psychopharmacology and Biological Psychiatry 07/2007; 31(5):975-96. DOI:10.1016/j.pnpbp.2007.03.005 · 3.69 Impact Factor
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ABSTRACT: Treatment for bipolar disorder consists of 2 goals: 1) managing urgent situations and 2) transitioning patients into maintenance therapy. Patients with bipolar disorder who present in urgent situations, including symptoms of suicidality, aggression, occupational impairment, legal involvement, and psychosis, require quick and efficient identification and resolution of symptoms. Once patients are stabilized, clinicians must then implement maintenance therapy to manage behavioral symptoms, promote optimal functioning, and ultimately, to reach full, functional recovery.The Journal of Clinical Psychiatry 04/2008; 69(3):e7. DOI:10.4088/JCP.0308e07 · 5.50 Impact Factor
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ABSTRACT: Despite the high rate of co-morbid alcoholism in bipolar disorder, the relationship between mood state, sex, and alcohol consumption patterns has not been well studied. An anonymous Internet survey was conducted from August 2002 to September 2005. The survey asked participants with bipolar disorder to self-report alcohol “quantity” consumed when euthymic, manic, or depressed. Of 366 persons with bipolar disorder, significantly more males (38%) than females (23%) and bipolar II (31%) than bipolar I (16%) respondents self-reported consuming a hazardous amount of alcohol during depression. These preliminary findings suggest that hazardous drinking in bipolar depression is more common in men and in patients with bipolar II disorder. Further study is encouraged to assess whether this alcohol intake increase is a possible attempt at self-medication of mood symptoms or an independent co-morbid factor related to alcoholism.Journal of Dual Diagnosis 07/2008; 4(3):291-302. DOI:10.1080/15504260802073451 · 0.80 Impact Factor
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