Clinical and legal characteristics of inmates with bipolar disorder

Bipolar Disorders in the Emergency Department

Affective disorders affect the way that people think and feel and are classified into unipolar disorders and bipolar disorders. Bipolar disorders represent a spectrum of these chronic mental health illnesses. Patients with bipolar disorder have high recurrence of acute symptoms, and on average spend 20% of their life in exacerbations characterized by mania, depression, or psychosis. Given the increased morbidity and mortality associated with bipolar disorders, it is imperative that the emergency physician remain vigilant when these patients seek emergency care.

Prevalence and correlates of police contact amongst youth with bipolar disorder

OBJECTIVES

While multiple studies have examined prevalence and correlates of police contact in adults with bipolar disorder (BD), literature on this topic in youth is sparse. We therefore examined the prevalence and correlates of police contact amongst youth with BD.

METHODS

The study included 197 youth with BD and 127 healthy controls, ages 14-20 years. Semi-structured interviews were used to determine diagnoses, treatment and police contact. The Life Problems Inventory examined self-reported trait impulsivity and emotional dysregulation. Analyses examined demographic and clinical variables among youth with versus without lifetime police contact. Variables that were associated with police contact at p<0.1 in univariate analyses were evaluated in a logistic regression model. Specific reasons for police contact, determined based on chart review, are reported descriptively.

RESULTS

Lifetime prevalence of police contact was significantly higher amongst youth with BD versus healthy controls (36% versus. 3%; χ ² = 47.58, p =<0.001). In multivariate analyses, age of BD onset, living with both natural parents, comorbid substance use disorder and conduct disorder, and psychiatric hospitalization were associated with police contact. Common reasons for police contact included shoplifting/theft and suicidality/self-harm .

LIMITATIONS

The cross-sectional and retrospective study design precludes conclusions regarding directionality of the observed associations and/or causal inferences.

CONCLUSIONS

One third of youth with BD experienced police contact. Correlates generally aligned with those observed with adults. Future longitudinal research is warranted to understand distal and proximal antecedents of police contact, with the goal of developing strategies to prevent police contact, incarceration, and related consequences.

Clinical correlates of socioeconomic status in adolescent bipolar disorder

BACKGROUND

Lower socioeconomic status (SES) is associated with symptomatic severity, comorbidity, and functional impairment in adults with bipolar disorder (BD). Little is known about clinical correlates of SES in adolescents with BD.

METHODS

Participants included 195 adolescents, 13-20 years old, with BD type I, II or not otherwise specified (NOS). Diagnoses were determined by standardized semi-structured interviews. Based on the Hollingshead scale, participants were divided into "low" (SES 1-3) and the "high" (SES 4-5) SES groups. Demographic and clinical correlates of SES were evaluated in univariate analyses; significant variables were evaluated in a logistic regression model.

RESULTS

Compared to participants in the high SES group (n = 150), participants in the low SES group (n = 45) were significantly younger, less likely to be of Caucasian race and living with natural parents. In the logistic regression model, controlling for age and race, the low SES group had higher risk of police contact or arrest (OR = 2.41, 95% CI:1.14-5.11, p = 0.022), less treatment with stimulants(OR = 0.20 95% CI: 0.06-0.67, p = 0.009), and more post-traumatic stress disorder (PTSD) (OR = 4.08, 95% CI:1.33-12.46, p = 0.014) compared to the high SES group. In sensitivity analyses that further controlled for intact family, the finding of higher rates of police contact or arrest was no longer significant.

LIMITATIONS

Cross-sectional design; higher-skewed SES sample.

CONCLUSIONS

Lower SES in adolescent BD is associated with higher legal risk, increased PTSD, and under-treatment of attention-deficit/hyperactivity disorder (ADHD). Future studies are needed to evaluate the inter-relationships of these correlates, using prospective designs that can evaluate the direction of these associations. Further studies incorporating neurobiological markers are also needed to explore mechanisms underlying SES-related differences in BD.

Mental Health Assessment of South Korean Adults on Probation

OBJECTIVE

The association of offender mental illness (including those on probation) with crime has long been the subject of social interest; however, systematic management has been insufficient. The study purpose was to analyze mental illness prevalence, proportion of first offenses and recidivism with the mental illness of those on probation.

METHODS

A total of 206 adults on probation were divided into groups (first offenders and repeat offenders) and they completed self-report instruments and clinical interviews designed to diagnose mental illness.

RESULTS

The mental illness prevalence among those on probation was considerably higher than that of the general population, and having mental illness was related to re-sentencing probation or recidivism. In particular, alcohol use disorder, major depressive episode, manic/hypomanic episode, and antisocial personality disorder were shown to affect recidivism.

CONCLUSION

To achieve the ultimate purpose of probation, social and systematic intervention on a mental health and medical basis may be required.

Predictors of criminal justice involvement in severe mania

BACKGROUND

Criminal justice problems among those with bipolar disorder lead to disruption in social functioning, treatment, and recovery. Understanding factors that contribute to arrest during episodes of illness can help inform approaches to risk management and improve clinical care.

METHODS

Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a longitudinal, nationally representative survey conducted in two waves were used to identify factors that predicted inter-wave criminal justice involvement during bipolar I manic episodes.

RESULTS

Over 10% of respondents experienced legal involvement during their most severe manic episode. Risk was found in a range of historical, clinical, and contextual factors. Multivariate analyses suggest risk is particularly high for those who are unemployed, non-white, have past juvenile detention, have a prior arrest (while using substances or when manic), used an illicit drug in the past year, and whose mania is characterized by both social and occupational impairment. Legal problems were particularly elevated among those who lacked health insurance while experiencing both social and occupational impairment.

LIMITATIONS

Respondents did not include prisoners and hospital inpatients; criminal justice problems were only assessed with regard to the most severe manic episode.

CONCLUSIONS

The particular array of factors that elevate the risk of legal involvement during manic episodes offers guidance when identifying prevention strategies and evaluating patients in clinical and forensic settings. Reducing such involvement will require that these issues be dealt with in the broader context of mental health and other services, which in turn necessitates providing adequate access to healthcare.

Bipolar disorder: how far are we from a rigorous definition and effective management?

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.