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Book part
Publication date: 21 April 2010

Kathryn Burrows

Purpose – This chapter explores the changing definition of bipolar disorder, examining how debates within psychiatry actually construct the definition of mental illness…

Abstract

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.

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Understanding Emerging Epidemics: Social and Political Approaches
Type: Book
ISBN: 978-1-84855-080-3

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Article
Publication date: 10 January 2020

Rachel Wakelin and Peter Oakes

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

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The Journal of Mental Health Training, Education and Practice, vol. 15 no. 1
Type: Research Article
ISSN: 1755-6228

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Article
Publication date: 1 September 2006

Heather Straughan and Michael Buckenham

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…

Abstract

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.

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Journal of Public Mental Health, vol. 5 no. 3
Type: Research Article
ISSN: 1746-5729

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Article
Publication date: 30 September 2015

Toru Uehara and Yoko Ishige

This study aims to examine the association of frontal functioning with subclinical bipolar spectrum by a newly developed convenient method. We investigated subclinical…

Abstract

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.

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Mental Illness, vol. 7 no. 2
Type: Research Article
ISSN: 2036-7465

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Article
Publication date: 25 October 2021

Melissa Husbands and Jerome Carson

The purpose of this paper is to suggest that student-led case studies are an important way to learn about mental health problems and to highlight this by presenting a case…

Abstract

Purpose

The purpose of this paper is to suggest that student-led case studies are an important way to learn about mental health problems and to highlight this by presenting a case study of the comedic genius Spike Milligan.

Design/methodology/approach

Celebrities live their lives in the public eye. In recent years, many have talked about their struggles with mental health. This paper is based on a student-led case study of the celebrity Spike Milligan.

Findings

This case study suggests one previously under-emphasised issue and argues that Spike Milligan’s wartime experiences may have led to post-traumatic stress disorder. Second, that he may have developed neuro-inflammation, through contracting sandfly fever during the war. This could have been an additional trigger for bipolar disorder.

Research limitations/implications

While this is a single case study, it draws on a wide variety of research sources to back up the arguments advanced.

Practical implications

Student-led case studies provide a way of engaging students more actively with mental health problems.

Social implications

Mental illness is complex, if not more complex, than physical health problems. Case studies of celebrities like Spike Milligan can help develop a public understanding of mental illness, as they already have a working knowledge about the person.

Originality/value

The case study illustrates how Bipolar 1 disorder is a complex and unique condition and that every individual’s illness has different predisposing characteristics. It suggests that student-led case studies are a helpful learning tool.

Details

The Journal of Mental Health Training, Education and Practice, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1755-6228

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Article
Publication date: 19 June 2020

Pedro Mota and Sofia Lourenço

The term borderline applied to personality dynamics was first introduced by Adolph Stern in 1938. This new term included a particular group of patients who, in an…

Abstract

Purpose

The term borderline applied to personality dynamics was first introduced by Adolph Stern in 1938. This new term included a particular group of patients who, in an organizational blurring, remained in the limbo between neurosis and psychosis. To find a more assertive and holistic characterization of borderline personality disorder (BPD), the purpose of this paper is to explore borderline phenomenology, setting boundaries and discussing points of approach and divergence of this personality disorder comparing them specifically to bipolar affective disorder (BAD) and also explore the differences in their treatment and prognosis.

Design/methodology/approach

This paper is a review and synthesis of the extant literature, mapping out the similar and unique aspects of each pathology.

Findings

Although there are approximation parameters between BPD and BAD, the phenomenology and the course of both diseases appear to be different. Indeed, this paper seems to have some uncertainty about the sphere of each entity and the domain of comorbidity. Despite the overlapping rates found, it is the understanding that the consequences and strategies for managing comorbidity are underexplored.

Originality/value

As the association of both disorders can be difficult not only in terms of management and understanding of their consequences and implications but also in long-term negative perpetuation, this review has direct implications for clinicians so that they can understand the similarities and particularities of each entity, leading to a more correct psychopathological approach in these individuals.

Details

Mental Health Review Journal, vol. 25 no. 2
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 25 January 2011

Tom Ratcliffe, Sam Dabin and Peter Barker

This paper aims to design and implement an audit of physical health monitoring for patients with schizophrenia or bipolar disorder in primary care.

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Abstract

Purpose

This paper aims to design and implement an audit of physical health monitoring for patients with schizophrenia or bipolar disorder in primary care.

Design/methodology/approach

Evidence‐based criteria for physical health monitoring were developed from current clinical guidelines. Physical health monitoring of 128 patients with a diagnosis of either schizophrenia or bipolar disorder was audited against these criteria in two urban GP practices.

Findings

The number of patients whose smoking history, alcohol consumption history, blood pressure and body mass index had been recorded in the preceding 15 months varied significantly by practice, whilst recording of blood cholesterol and diabetes status did not. Patients with a diagnosis of schizophrenia were significantly more likely to have had a diabetes status recorded in the preceding 15 months compared to patients with bipolar disorder.

Research limitations/implications

Standards for compliance with audit criteria need to be debated and agreed with stakeholders. Further research is needed into how physical healthcare services can effectively engage patients with serious mental illness.

Practical implications

Audit of physical health monitoring in primary care is feasible and could be used to identify shortcomings in physical healthcare for people with serious mental illness. Inviting patients on practices' mental health registers for cardiovascular risk screening should be considered.

Social implications

Regular audit of physical health monitoring in people with schizophrenia or bipolar disorder may help ensure equitable healthcare delivery for patients with serious mental illness.

Originality/value

This paper presents an audit methodology that primary care trusts and general practitioners can use to assess how effectively the physical health of people with serious mental illness is being monitored.

Details

Clinical Governance: An International Journal, vol. 16 no. 1
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 16 September 2011

Clare Dolman and Sarah Turvey

There is evidence to suggest an association between mood disorders, in particular bipolar disorder, and creativity. This paper aims to examine the evidence that the writer…

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249

Abstract

Purpose

There is evidence to suggest an association between mood disorders, in particular bipolar disorder, and creativity. This paper aims to examine the evidence that the writer Herman Melville suffered from bipolar disorder.

Design/methodology/approach

An interdisciplinary approach is adopted, examining the genetic and biographical evidence as well as textual examples that illustrate the argument in his masterpiece Moby Dick.

Findings

Taking the genetic, behavioural, and textual evidence together, it is concluded that the likelihood that Melville did have bipolar disorder is high.

Research limitations/implications

Retrospective analysis of the biographies and work of deceased writers has acknowledged limitations. Close examination of all Melville's literary output would be useful to either add credence to this theory or refute it.

Social implications

Adding to the evidence that revered writers and artists were on the bipolar disorder spectrum helps people with the condition feel more positive and reduces stigma.

Originality/value

Close literary examination of textual examples of hypomanic writing, combined with a psychological approach to Melville's biography provides evidence that Melville's mental illness contributed positively to his creativity as a writer and is therefore evidence that this condition has some benefits to society.

Details

Mental Health Review Journal, vol. 16 no. 3
Type: Research Article
ISSN: 1361-9322

Keywords

Content available
Article
Publication date: 2 September 2014

Nilamadhab Kar, Surabhi R. Hullumane and Carol Williams

While hypothyroidism is common in lithium-treated patients, thyrotoxicosis is rarely reported. We present a female patient on lithium for maintenance therapy of bipolar

Abstract

While hypothyroidism is common in lithium-treated patients, thyrotoxicosis is rarely reported. We present a female patient on lithium for maintenance therapy of bipolar affective disorder, who developed thyrotoxicosis for few months which was followed by hypothyroidism which continued. There was no further thyrotoxicosis episode during a five year follow up period. While she was treated for thyroid dysfunction, lithium was continued. There was no clinical impact on the maintenance of the bipolar affective disorder during the follow up period; she was maintained well in the community.

Details

Mental Illness, vol. 6 no. 2
Type: Research Article
ISSN: 2036-7465

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Article
Publication date: 2 January 2018

Carlos Peña-Salazar, Francesc Arrufat, Josep Manel Santos, Ramón Novell and Juan Valdés-Stauber

Studies on psychiatric comorbidity in individuals with borderline intellectual functioning (BIF) are scarce, particularly with respect to certain diseases frequently…

Abstract

Purpose

Studies on psychiatric comorbidity in individuals with borderline intellectual functioning (BIF) are scarce, particularly with respect to certain diseases frequently observed in clinical practice. The purpose of this paper is to discuss the relevance of epidemiological research to psychiatric comorbidity in people with BIF.

Design/methodology/approach

Systematic searches of MEDLINE, EMBASE and Cochrane databases. Inclusion criteria: publications about BIF appearing between 1995 and 2017; epidemiological findings about comorbid mental disorders in individuals with BIF; and studies comparing BIF, mild intellectual disability (ID) and normal intellectual functioning. The discussion covers 24 of the 224 studies initially considered.

Findings

The most frequent psychiatric comorbidity reported was personality, post-traumatic as well as psychotic disorders, followed by psychosis, attention deficit and hyperactivity disorder, bipolar and sleep disorders. Individuals with BIF exhibit psychiatric comorbidity more frequently than individuals with normal intellectual functioning. Some psychiatric comorbidities were similarly prevalent in patients with BIF and those with mild or moderate ID; however, the prevalence was always higher in people with severe ID. Environmental factors, especially psychosocial adversity, seem to play an important mediating role. Pharmacotherapy is the most common treatment approach, including behavioural disorders.

Originality/value

This review of literature on mental disorders in people with BIF demonstrates the epidemiological relevance of psychiatric comorbidity, especially personality and post-traumatic disorders. Mental health professionals, general practitioners and other workers in outpatient settings have to be aware about the vulnerability and even fragility of people with BIF.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 12 no. 1
Type: Research Article
ISSN: 2044-1282

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