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Purpose – This chapter explores the changing definition of bipolar disorder, examining how debates within psychiatry actually construct the definition of mental illness…
Purpose – This chapter explores the changing definition of bipolar disorder, examining how debates within psychiatry actually construct the definition of mental illness, thereby creating the appearance of an emerging epidemic with increasing prevalence.
Method – I review the recent psychiatric and epidemiological research to reveal that the intellectual and scientific debates that occur in the psychological laboratory and in survey research are in fact falsely increasing the figures that show that an epidemic of bipolar is emerging.
Findings – For centuries, bipolar disorder was equated with severe psychosis and had a prevalence rate between 0.4% and 1.6%. As spectrum and subthreshold conceptions of bipolar disorder become established in official psychiatric diagnostic manuals, however, estimates of the prevalence of bipolar spectrum disorders have risen to almost 25%. I demonstrate that nearly all of this increase is a result of changes in the scientific and intellectual definition of bipolar disorders among psychiatric professionals, and that rates of symptoms are not in fact increasing.
Contribution to field – The arbitrariness of diagnostic thresholds naturally leads researchers to argue for lower thresholds. This allows more individuals who were previously considered psychiatrically normal to be reclassified as psychiatrically disordered. Lowering diagnostic thresholds increases the risk of confusing normal elation or sadness with disordered states, increasing the potential of false-positive diagnoses and the false impression of rising rates of disorder.
Research indicates that the diagnostic label of Bipolar Disorder is being both over and under-used in mental health services. Disagreement between clinicians in how the…
Research indicates that the diagnostic label of Bipolar Disorder is being both over and under-used in mental health services. Disagreement between clinicians in how the diagnosis of Bipolar Disorder is perceived and how the label is used can make it difficult to establish and uphold consistent care. This may lead to the experience of negative emotions for service users and poor engagement with intervention. Therefore, the purpose of this paper is to explore whether clinicians do hold different perceptions of the diagnosis of Bipolar Disorder, with the view of providing insight into how this may impact service provision.
Q-methodology was used to investigate the subjective viewpoints of 19 clinicians from mental health community teams supporting individuals with a diagnosis of Bipolar Disorder. The completed Q-sorts were subject to analysis using Q-methodology analysis software.
Three main factors representing the viewpoints of participants were identified: seeing the person and their experience, promoting quality through standardised processes and understanding the function of diagnostic labels. All three factors agreed that more than one assessment appointment should be required before a diagnosis of Bipolar Disorder was given and that the focus should be on the difficulties experienced rather than the diagnostic label.
These three viewpoints provide different perspectives of the diagnosis of Bipolar Disorder, which are likely to impact on service provision. Services may benefit from a better integration of the viewpoints, noting the important functions of each viewpoint and being guided by individuals’ needs.
This paper reports outcomes from a holistic, recovery‐based, user‐led group training for people with DSM‐IV bipolar disorder. Drawn from professional therapies and…
This paper reports outcomes from a holistic, recovery‐based, user‐led group training for people with DSM‐IV bipolar disorder. Drawn from professional therapies and personal experience of the illness by the user‐researcher, the training was delivered over 12 weekly sessions. Using a case‐study approach, an experimental design incorporated pilot (eight participants), main study (five) and control groups (six). Self‐report scales measured mood, coping, empowerment and quality of life pre‐, post‐ and six months post‐training. Semi‐structured interviews noted individual change within the same time frame. Interviews with mental health professionals, medical note analysis and user‐researcher observations also informed the study. Findings from self‐report questionnaires indicated that participants experienced improved mood stability, symptom severity, coping and quality of life and greater empowerment. Out of the six controls, two indicated slight but slow recovery, four continued to use poor coping skills, and two of these four experienced major relapses.
This study aims to examine the association of frontal functioning with subclinical bipolar spectrum by a newly developed convenient method. We investigated subclinical…
This study aims to examine the association of frontal functioning with subclinical bipolar spectrum by a newly developed convenient method. We investigated subclinical bipolar tendency and frontal lobe activation during word productions using multi-channel near infrared spectroscopy. Participants: 44 healthy university students (mean ages 20.5 years old, and 29 female) gave their written informed consent, and we strictly protected privacy and anonymity was carefully preserved. A 13-items self-report questionnaire (Mood Disorders Questionnaire; MDQ) and a 16-channel near-infrared spectroscopy were used to compare frontal activations between two samples divided by median (4 points) of the total MDQ scores and to analyze correlations between relative changes of cerebral blood volume and bipolarity levels. There was no case suspected as bipolar disorders by MDQ screening (mean 3.4, max 10). Significant differences in lower activations were noted in the right and left pre-frontal cortex (PFC) with higher bipolarity scores using the specific software to analyze the NIRS waveform (P<0.05). Total MDQ were correlated significantly with frontal activation negatively in many channels; therefore, we conducted multiple linear regression to select significant frontal activations using the MDQ as a dependent variable. Stepwise method revealed that activation in left lateral PFC was negatively associated to bipolar tendency, and this regression model was significant (R2=0.10, F=4.5, P=0.04). Differences in frontal functioning suggest that subclinical bipolar tendencies might be related to left lateral PFC activations. It should be confirmed whether the identical pattern can be identified for clinical subjects with bipolar disorders.
In this article the mathematical formula of entropy is used to evaluate the degree of anarchy specific to multipolar, bipolar, and balance of power international political systems. Several entropic properties characteristic to these systems are deduced, and it is proved that alliances decrease international systems' entropy. Each international system it is observed is characterized by a specific amount of structural strain, and that under the assumptions of structural neo‐realism the entropy and structural strain move in opposite ways. On the basis of these findings a few properties regarding the stability of international systems are divided and the effects of alliances on international structural strain are examined. In the last part of the paper theoretical conclusions are tested against three empirical cases – the Cold War bipolar system, the XIXth Century European system, and the current one. The article ends with several methodological suggestions regarding a possible generalization of the entropic model.
Purpose – Over the last years, in the United States there has been significant increase in the consumption of pharmaceuticals for the treatment of mental disorders. More…
Purpose – Over the last years, in the United States there has been significant increase in the consumption of pharmaceuticals for the treatment of mental disorders. More specifically, the number of clinical diagnosis of bipolar disorders in young people has increased by 40 times over the last 10 years. The purpose of this chapter is to analyse the growth of bipolar disorder diagnosis using a sociological frame.
Methodology/approach – The methodology is based on the concepts proposed by the ‘conflictualist’ perspective of medical sociology. Medicalization, that is, the extension of medical categories in everyday life, is the main concept on which the chapter is constructed. The ‘syndromization’ of the Diagnostic and Statistical Manual of Mental Disorders lowers the threshold above which someone may be diagnosed with bipolarism. Moreover, advertisements push people to seek for pharmaceutical treatment for conditions of ‘normal’ sadness.
Findings – This work shows the importance of the analysis of ‘medical’ phenomena by approaches taken from social sciences. Bipolar disorder can be a terrible and painful disease, but it seems that there is the possibility that it is over-diagnosed.
Contribution to the field – In this epidemics of diagnosis of bipolar disorder it is central to integrate the medical perspective with other dimensions: the classification of mental disease, the advertisement for drugs and the cultural aspects of a given society.
A compound emitter heterojunction bipolar transistor (HBT) structure that incorporates an additional heterojunction within the emitter for minority carrier confinement has…
A compound emitter heterojunction bipolar transistor (HBT) structure that incorporates an additional heterojunction within the emitter for minority carrier confinement has been proposed. In this new device configuration, the single wide band‐gap emitter layer in a conventional HBT is replaced by two sub‐layers of wide band‐gap material, with the sub‐layer nearer the base having a narrower band‐gap. By means of numerical simulations, the compound emitter HBT was found to perform better than comparable conventional HBTs. With the AlGaAs(n) / GaAs heterostructure system, the optimum compound emitter HBT structure was found to be Al0.3Ga0.7As(n) ‐ Al0. 2Ga0.8As(n) / GaAs with grading at the two hetero‐interfaces. It has a low turn‐on voltage that is almost identical to that of a homojunction GaAs bipolar transistor with similar doping conditions. Compared with a conventional single emitter layer Al0.3Ga0.7As/GaAs HBT, the optimum compound emitter HBT has an enhancement in the current gain by approximately 2 folds, an improvement in the uniform current gain region from 2 to 4 decades of collector current density, and a slight increase in the unity‐gain cut‐off frequency fT by about 7 %.
Although first rank symptoms focus on positive symptoms of psychosis they are shared by a number of psychiatric conditions. The difficulty in differentiating bipolar…
Although first rank symptoms focus on positive symptoms of psychosis they are shared by a number of psychiatric conditions. The difficulty in differentiating bipolar disorder from schizophrenia with affective features has led to a third category of patients often loosely labeled as schizoaffective. Research in schizophrenia has attempted to render the presence or absence of negative symptoms and their relation to etiology and prognosis more explicit. A dichotomous population is a recurring theme in experimental paradigms. Thus, schizophrenia is defined as process or reactive, deficit or non-deficit and by the presence or absence of affective symptoms. Laboratory tests confirm the clinical impression showing conflicting responses to dexamethasone suppression and clearly defined differences in autonomic responsiveness, but their patho-physiological significance eludes mainstream theory. Added to this is the difficulty in agreeing to what exactly constitutes useful clinical features differentiating, for example, negative symptoms of a true deficit syndrome from features of depression. Two recent papers proposed that the general and specific cognitive features of schizophrenia and major depression result from a monoamine-cholinergic imbalance, the former due to a relative muscarinic receptor hypofunction and the latter, in contrast, to a muscarinic hypersensitivity exacerbated by monoamine depletion. Further development of these ideas will provide pharmacological principles for what is currently an incomplete and largely, descriptive nosology of psychosis. It will propose a dimensional view of affective and negative symptoms based on relative muscarinic integrity and is supported by several exciting intracellular signaling and gene expression studies. Bipolar disorder manifests both muscarinic and dopaminergic hypersensitivity. The greater the imbalance between these two receptor signaling systems, the more the clinical picture will resemble schizophrenia with bizarre, incongruent delusions and increasingly disorganized thought. The capacity for affective expression, by definition a non-deficit syndrome, will remain contingent on the degree of preservation of muscarinic signaling, which itself may be unstable and vary between trait and state examinations. At the extreme end of muscarinic impairment, a deficit schizophrenia subpopulation is proposed with a primary and fixed muscarinic receptor hypofunction.
The genomic profile of bipolar disorder and schizophrenia overlap and both have a common dopaminergic intracellular signaling which is hypersensitive to various stressors. It is proposed that the concomitant muscarinic receptor upregulation differentiates the syndromes, being marked in bipolar disorder and rather less so in schizophrenia. From a behavioral point of view non-deficit syndromes and bipolar disorder appear most proximate and could be reclassified as a spectrum of affective psychosis or schizoaffective disorders. Because of a profound malfunction of the muscarinic receptor, the deficit subgroup cannot express a comparable stress response. None -theless, a convergent principle of psychotic features across psychiatric disorders is a relative monoaminergic-muscarinic imbalance in signal transduction.
The purpose of this paper is to examine the mental health literacy (MHL) of British community pharmacists.
The purpose of this paper is to examine the mental health literacy (MHL) of British community pharmacists.
A survey instrument was sent by facsimile to a random sample of community pharmacists in England, Scotland and Wales. The survey instrument contained items concerning recognition of the symptoms of depression, bipolar disorder or schizophrenia, the helpfulness of a range of interventions, mental health stigma and the degree of comfort providing pharmaceutical care to people with mental health problems.
Among community pharmacists (n=329) symptom recognition was high for depression but lower for bipolar disorder and schizophrenia. Pharmacists showed a preference for evidence-based interventions and support for psychological therapies and physical activity for all three mental health problems. Pharmacists expressed less comfort providing pharmacy services to people with bipolar disorder, schizophrenia and depression than cardiovascular disease. Mental health stigma was higher for schizophrenia and bipolar disorder than depression, with many pharmacists holding misperceptions about schizophrenia and bipolar disorder.
The study findings indicate the need for enhanced mental health content in the undergraduate pharmacy curriculum which should challenge misperceptions of mental illness.
This is the first study to investigate the MHL of British community pharmacists.
The effects of polysilicon emitter on the high frequency performance of bipolar transistors have been investigated numerically. The presence of polysilicon grain…
The effects of polysilicon emitter on the high frequency performance of bipolar transistors have been investigated numerically. The presence of polysilicon grain boundaries was found to slow down the response of the device. This resulted in a lower fT for polysilicon emitter bipolar transistors with a clean polysilicon/ mono‐crystalline silicon interface compared to conventional transistors with an identical emitter‐base junction depth. The interfacial oxide layer that could exist at the polysilicon/mono‐crystalline silicon interface can, depending on the relative thickness of the polysilicon and mono‐crystalline silicon emitter regions, either improve or deteriorate the high frequency performance of the device. For a mono‐crystalline silicon emitter region that is much thinner than the polysilicon emitter region, the lower the tunnelling probability of the interfacial oxide layer the better is the improvement in fT. However, if the thickness of the mono‐crystalline silicon emitter region is made larger with respect to the polysilicon emitter region, the converse can be true.