Clinical and legal characteristics of inmates with bipolar disorder

ArticleinCurrent Psychiatry Reports 7(6):478-84 · January 2006with36 Reads
DOI: 10.1007/s11920-005-0070-z · Source: PubMed
Abstract
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.
    • "Given those results, having included female inmates in the study might have yielded higher rates for previous hospitalization. In another example, a study by Quanbeck et al. (2004) found that 49 of the 66 Los Angeles County jail inmates identified as bipolar had been hospitalized in the month prior to their arrest (as cited in Quanbeck, McDermott, & Frye, 2005). Even higher psychiatric hospitalizations were found in a later study by Way, Sawyer, Lilly, Moffitt, and Stapholz (2008). "
    [Show abstract] [Hide abstract] ABSTRACT: This paper sought to synthesize what is currently known about mentally ill offenders in American jails and prisons based upon the most recent government and congressional reports and relevant literature review. The primary goal is to provide a detailed picture of the status of mentally ill offenders—including prevalence, basic demographic information, bio-psycho-social status, mental health, and family histories—and also to identify the problems, conditions, and obstacles faced while under the jurisdiction of the criminal justice system. Mentally ill offenders are constitutionally guaranteed basic mental health treatment. A review of the literature indicates that this constitutional guarantee is not being adequately fulfilled. Implications and suggestions for change are discussed.
    Full-text · Article · Jul 2013
  • [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.
    Article · Jul 2007
  • [Show abstract] [Hide abstract] ABSTRACT: Dr. Jain reiterated that bipolar disorder is a common problem, and psychiatrists and nonpsychiatrists alike face urgent situations in clinical practice. Many stakeholders have a vested interest in optimizing patients' outcomes, including the patients themselves,78 their families and caregivers,78,79 their workplaces,80 and society at large81; each one can be dramatically and adversely affected by the devastating impact of this debilitating disorder. Bipolar disorder not only can cause loss of life through suicide or other mortality but also can lead to family dysfunction and occupational and educational disruption,2 and therefore, society as a whole suffers from urgently ill bipolar disorder patients who are not quickly and efficiently stabilized. In summation, Dr. Jain offered the following takehome points: • Urgent presentations of bipolar disorder are common in all physicians' offices • Accurate diagnosis of the various phases of bipolar disorder (manic, depressive, or mixed) is critical to effectively manage patients • Quick and accurate assessment for patient self-harm or harm to others is necessary to treat urgent situations appropriately • Offering systematic interventions that are rapidly effective is mandated, and focusing on efficacy and tolerability will help guide clinicians • Full patient and support system involvement in psychoeducation and psychotherapy will help reduce the burden of bipolar disorder.
    Article · Jul 2007
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