scholarly journals Violence, stigma and psychiatric diagnosis: the effects of a history of violence on psychiatric diagnosis

2006 ◽  
Vol 30 (7) ◽  
pp. 254-256 ◽  
Author(s):  
Tom Clark ◽  
Renarta Rowe
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Diagnosis ◽  
Bipolar Affective Disorder ◽  
Clinical Implications ◽  
Clinical Vignettes ◽  
Diagnostic Decision ◽  
History Of ◽  
History Of Violence ◽  
The Uk ◽  
Diagnostic Decision Making

Aims and MethodThe aim of the study was to investigate whether psychiatrists consider that patients with schizophrenia present a greater risk of violence than patients with other forms of mental illness. Two pairs of clinical vignettes were devised. In each pair, one contained a history of violence and one did not. One vignette was mailed to each of 2000 consultant psychiatrists in the UK. Respondents were asked to give a preferred diagnosis. Rates of diagnosis of bipolar disorder, schizoaffective disorder and schizophrenia were compared within vignette pairs.ResultsFor each pair of vignettes, the rate of diagnosis of schizophrenia was higher (33 v. 21.5%, P=0.008 and 44.4 v. 32.1%, P=0.011), and the rate of diagnosis of bipolar disorder was lower (44.2 v. 62.6%, P<0.0005 and 34.9 v. 49.3%, P=0.004), among those who received the vignette containing a history of violence.Clinical ImplicationsA history of violence may lead to an increased likelihood of receiving a diagnosis of schizophrenia as opposed to bipolar affective disorder. This bias in diagnostic decision-making may affect the treatment received by a patient and may perpetuate and exacerbate the stigma associated with a diagnosis of schizophrenia.

scholarly journals Gambling problems in bipolar disorder in the UK: Prevalence and distribution

2015 ◽  
Vol 207 (4) ◽  
pp. 328-333 ◽  
Author(s):  
Lisa Jones ◽  
Alice Metcalf ◽  
Katherine Gordon-Smith ◽  
Liz Forty ◽  
Amy Perry ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Problem Gambling ◽  
Severity Index ◽  
Gambling Problems ◽  
Rapid Cycling ◽  
Probable Significance ◽  
History Of ◽  
Gambling Severity ◽  
The Uk

BackgroundNorth American studies show bipolar disorder is associated with elevated rates of problem gambling; however, little is known about rates in the different presentations of bipolar illness.AimsTo determine the prevalence and distribution of problem gambling in people with bipolar disorder in the UK.MethodThe Problem Gambling Severity Index was used to measure gambling problems in 635 participants with bipolar disorder.ResultsModerate to severe gambling problems were four times higher in people with bipolar disorder than in the general population, and were associated with type 2 disorder (OR = 1.74, P = 0.036), history of suicidal ideation or attempt (OR = 3.44, P = 0.02) and rapid cycling (OR = 2.63, P = 0.008).ConclusionsApproximately 1 in 10 patients with bipolar disorder may be at moderate to severe risk of problem gambling, possibly associated with suicidal behaviour and a rapid cycling course. Elevated rates of gambling problems in type 2 disorder highlight the probable significance of modest but unstable mood disturbance in the development and maintenance of such problems.

Who Responds to Prophylactic Lithium Therapy?

1993 ◽  
Vol 163 (S21) ◽  
pp. 20-26 ◽  
Author(s):  
M. T. Abou-Saleh
Keyword(s):  
Bipolar Disorder ◽  
Family History ◽  
Bipolar Affective Disorder ◽  
Positive Family History ◽  
Specific Treatment ◽  
Predictors Of Outcome ◽  
Powerful Predictor ◽  
Bipolar Illness ◽  
History Of ◽  
Psychotic Features

The search for predictors of outcome has not been particularly rewarding, and the use of lithium remains empirical: a trial of lithium is the most powerful predictor of outcome. However, lithium is a highly specific treatment for bipolar disorder. In non-bipolar affective disorder, factors of interest are correlates of bipolar disorder: mood-congruent psychotic features, retarded-endogenous profile, cyclothymic personality, positive family history of bipolar illness, periodicity, and normality between episodes of illness.

scholarly journals Care Programme Approach – documentation of past risk-related behaviour

2003 ◽  
Vol 27 (8) ◽  
pp. 298-300 ◽  
Author(s):  
Peter Dick ◽  
Tessa Durham ◽  
Mitchell Stewart ◽  
Scott Kane ◽  
Jim Duffy
Keyword(s):  
Clinical Information ◽  
Relevant Information ◽  
Risk Category ◽  
Clinical Implications ◽  
Routine Practice ◽  
Care Programme ◽  
Related Information ◽  
History Of ◽  
Self Harm ◽  
History Of Violence

Aims and MethodThe aim of the study was to assess the practicality of extracting past risk-related information from case records and to assess how this process might be cost-effectively incorporated in routine practice. Case records of 43 patients referred to the Care Programme Approach in Dundee were examined.ResultsOur study yielded relevant information – 39% of patients had a history of violence, 58% of self-harm or suicide, 58% of severe self-neglect and 72% of non-compliance with medication. However, it took an average of 5 hours to conduct a thorough review of each case because the notes were bulky and poorly organised.Clinical ImplicationsRetrospective review of conventional case records in routine practice is likely to be incomplete and misleading. Prospective recording should be practicable if used selectively, but requires a standardised approach to clinical recording and case note maintenance. The risk recording system we developed, incorporating a dated index of incidents by risk category, followed by brief summaries of each incident, provides key clinical information not available from a simple check list while not sacrificing brevity.

scholarly journals Assessing whether psychiatric trainees feel safe in the workplace

2012 ◽  
Vol 36 (3) ◽  
pp. 93-96 ◽  
Author(s):  
Catia Acosta ◽  
James Warner ◽  
Michael Kopelman ◽  
Ramin Nilforooshan
Keyword(s):  
Clinical Practice ◽  
Annual Meeting ◽  
Physical Assault ◽  
Clinical Implications ◽  
Training Course ◽  
History Of ◽  
History Of Violence ◽  
Level Of Training ◽  
Verbal Assault

Aims and methodPrevious studies have shown that 17 to 60% of psychiatric trainees have been physically or verbally assaulted. To measure the frequency of assaults and the trainees' reactions, we conducted a retrospective self-reported survey of attendees at MRCPsych teaching courses in south London and at an annual meeting of psychiatric trainees.ResultsOverall, 64% of the questionnaires distributed were returned completed. Of the trainees who responded, 41% had been physically assaulted at least once and 89% had been verbally assaulted. As a result of the assault, 34% of trainees were subsequently more risk aware and 11% were now hesitant to assess patients with a history of violence. There was no association between the level of training or attendance at a breakaway training course and having been subject to physical assault.Clinical implicationsOur study showed unacceptable levels of physical and verbal assault on psychiatric trainees and an important effect of those incidents on clinical practice.

Childhood exposure to interpersonal violence is associated with greater transdiagnostic integration of psychiatric symptoms

2020 ◽  
pp. 1-9
Author(s):  
Justin D. Russell ◽  
Taylor J. Keding ◽  
Quanfa He ◽  
James J. Li ◽  
Ryan J. Herringa
Keyword(s):  
Interpersonal Violence ◽  
Psychiatric Comorbidity ◽  
Psychiatric Symptoms ◽  
Treatment Resistance ◽  
Clinical Implications ◽  
Treatment Resistant ◽  
Childhood Exposure ◽  
Resistant Population ◽  
History Of ◽  
History Of Violence

Abstract Background Childhood exposure to interpersonal violence (IPV) may be linked to distinct manifestations of mental illness, yet the nature of this change remains poorly understood. Network analysis can provide unique insights by contrasting the interrelatedness of symptoms underlying psychopathology across exposed and non-exposed youth, with potential clinical implications for a treatment-resistant population. We anticipated marked differences in symptom associations among IPV-exposed youth, particularly in terms of ‘hub’ symptoms holding outsized influence over the network, as well as formation and influence of communities of highly interconnected symptoms. Methods Participants from a population-representative sample of youth (n = 4433; ages 11–18 years) completed a comprehensive structured clinical interview assessing mental health symptoms, diagnostic status, and history of violence exposure. Network analytic methods were used to model the pattern of associations between symptoms, quantify differences across diagnosed youth with (IPV+) and without (IPV–) IPV exposure, and identify transdiagnostic ‘bridge’ symptoms linking multiple disorders. Results Symptoms organized into six ‘disorder’ communities (e.g. Intrusive Thoughts/Sensations, Depression, Anxiety), that exhibited considerably greater interconnectivity in IPV+ youth. Five symptoms emerged in IPV+ youth as highly trafficked ‘bridges’ between symptom communities (11 in IPV– youth). Conclusion IPV exposure may alter mutually reinforcing symptom co-occurrence in youth, thus contributing to greater psychiatric comorbidity and treatment resistance. The presence of a condensed and unique set of bridge symptoms suggests trauma-enriched nodes which could be therapeutically targeted to improve outcomes in violence-exposed youth.

A Retrospective Case-Note Study of Bipolar Disorder in Old Age

1991 ◽  
Vol 158 (4) ◽  
pp. 485-490 ◽  
Author(s):  
John Snowdon
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Age Of Onset ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Case Note ◽  
Retrospective Case ◽  
History Of ◽  
Study Case ◽  
Reason For Admission

In a replication of an earlier published study, case notes of 75 elderly in-patients with bipolar affective disorder were examined. Few of the patients had experienced a manic episode before the age of 40. Mean age of onset of affective disorder was 46 years, and first manic episode at 60 years. Cerebral insults before the first manic attacks were recorded in a substantial number of cases, and a family history of mental illness was less common among this group. Bipolar affective disorder is relatively common as a reason for admission of elderly patients.

P01-224-Diagnosis and misdiagnosis of bipolar disorder: decision making of Austrian psychiatrists

2011 ◽  
Vol 26 (S2) ◽  
pp. 225-225
Author(s):  
C. Lex ◽  
C. Rados ◽  
T.D. Meyer
Keyword(s):  
Decision Making ◽  
Bipolar Disorder ◽  
Preliminary Data ◽  
Relevant Information ◽  
Diagnostic Decision ◽  
Icd 10 ◽  
Case Vignettes ◽  
Dsm Iv ◽  
Diagnostic Decision Making

IntroductionStudies show that bipolar disorder is often misdiagnosed. One reason for misdiagnosis may be that psychiatrists do not rely strictly on ICD or DSM criteria but consider some symptoms, e.g., „decreased need for sleep”, as more critical than others. Another reason could be that the diagnosis of bipolar disorder is associated with the total number of reported symptoms.ObjectivesFirstly, we investigate if an individual is more likely to be diagnosed with bipolar disorder if he/she reports a „decreased need for sleep”. Secondly, we explore if a high number of reported relevant symptoms increases the likelihood of a bipolar diagnosis.MethodFive case vignettes that varied in respect to the relevant information were sent to 400 randomly selected Austrian psychiatrists. The vignettes contained all information that is required to diagnose a bipolar disorder according to ICD-10 or DSM-IV. The psychiatrists were asked to return a questionnaire that collected data on their diagnostic decision making.ResultsPreliminary data will be reported and discussed.

scholarly journals Comorbid medical illness in bipolar disorder

2014 ◽  
Vol 205 (6) ◽  
pp. 465-472 ◽  
Author(s):  
Liz Forty ◽  
Anna Ulanova ◽  
Lisa Jones ◽  
Ian Jones ◽  
Katherine Gordon-Smith ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempts ◽  
Mental Health Disorder ◽  
Acute Onset ◽  
Medical Illness ◽  
Illness Burden ◽  
Increased Risk ◽  
History Of ◽  
Dsm Iv ◽  
The Uk

BackgroundIndividuals with a mental health disorder appear to be at increased risk of medical illness.AimsTo examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden.MethodParticipants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria.ResultsWe found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset.ConclusionsBipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role.Declarations of interestNone.

scholarly journals Falls in Scottish homicide: Lessons for homicide reduction in mental health patients

2017 ◽  
Vol 41 (4) ◽  
pp. 185-186
Author(s):  
John H. M. Crichton
Keyword(s):  
Mental Health ◽  
Crime Reduction ◽  
Safety Planning ◽  
Violence Reduction ◽  
Mental Health Patients ◽  
History Of ◽  
History Of Violence ◽  
Domestic Setting ◽  
The Uk ◽  
Gas Supply

SummaryThe sustained fall in Scottish homicide rates follows crime reduction measures informed by the epidemiology of suicide. The violence reduction unit targeted young men carrying knives in public. The restriction of weapons immediately to hand appears to have caused an absolute fall in homicide just as suicide reduction was observed following changes to domestic gas supply. Further homicide reduction may be accomplished in the domestic setting with targeted changes in kitchen knife design in home safety planning for high-risk households. Most commonly homicides involving those in recent contact with mental health services in the UK have domestic characteristics and similar safety planning may be targeted at those with mental disorder and a history of violence.

scholarly journals Efficacy of Electroconvulsive Therapy for Comorbid Frontotemporal Dementia with Bipolar Disorder

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Sean Paul ◽  
Jennifer Goetz ◽  
Jeffrey Bennett ◽  
Tessy Korah
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disorder ◽  
Frontotemporal Dementia ◽  
Affective Disorder ◽  
Electroconvulsive Therapy ◽  
Potential Application ◽  
Bipolar Affective Disorder ◽  
Depressed Type ◽  
Beneficial Effects ◽  
History Of

Challenges encountered in the diagnosis and treatment of frontotemporal dementia (FTD) are further confounded when presented with comorbid psychiatric disorder. Here we report a case of progressive FTD in a patient with a long history of bipolar affective disorder (BAD) 1, depressed type. We also report beneficial effects of electroconvulsive therapy and its potential application in similar comorbid disorders.

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