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The purpose of this paper is to determine: the extent to which an intellectual disability diagnosis meets current diagnostic and statistical manual of mental disorders (DSM) diagnostic criteria; the prevalence of reported autism spectrum disorders (ASD); and the extent to which assessment of developmental issues is central to the diagnosis of psychotic disorder, in patients discharged with a diagnosis of psychotic disorder and intellectual disabilities.

Of all patients discharged with psychotic disorder during a four‐year period (n=3339), chart reviews were completed on those also diagnosed with intellectual disability or borderline IQ.

The findings if this paper are threefold: only 39 percent of the 41 individuals discharged with a diagnosis of psychotic disorder and intellectual disability met documented DSM criteria for intellectual disability; the prevalence of reported ASD was much lower than expected; and the average number of different discharge diagnoses per individual over time was 4.8. Schizophrenia diagnoses were made early in the diagnostic process and tended to persist even when ASD concerns were documented.

The results support the need to systematically assess the developmental issues of patients with intellectual disability as part of the psychiatric diagnostic formulation. Differential diagnoses of psychotic‐like behaviours seen in people with intellectual disability, and alternative frameworks for understanding these behaviours, which in turn should guide more effective interventions and treatment, are discussed.

The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC‐LD) was introduced in 2003 in an attempt to improve accuracy of diagnosis in the intellectual disability population. The paper aims to apply this system to a sample of a population with intellectual disability to further investigate its usefulness in the clinical setting.

A sample of 50 patients within an intellectual disability service was identified. Each individual was interviewed by a registrar in psychiatry of intellectual disability in the presence of their key worker or a carer that knew the individual well. Chart notes were extensively reviewed for clearly documented history of psychiatric symptoms and behavioural difficulties. The information gathered was applied as per the DC‐LD criteria to identify appropriate diagnoses. Previously documented diagnoses were also recorded for comparison purposes.

There was considerable discrepancy between the rates of psychiatric diagnoses after application of DC‐LD and rates of previously documented diagnoses within the sample. Use of DC‐LD led to the reclassification of many previously documented diagnoses, mainly as behavioural disorders. There were also discrepancies between rates of diagnosis of pervasive developmental disorders and Alzheimer's disease before and after use of DC‐LD.

This study adds to the evidence regarding the usefulness of DC‐LD in the intellectual disability population and also highlights the shortcomings of non‐systematic methods of diagnosis. It was agreed that DC‐LD criteria be applied to all service users in this population in the future.

The aim of this article is an analysis of the links between race and psychotic illness, psychiatric diagnosis and treatment, as well as psychiatric, police and prison violence against people with mental health problems. The analysis focuses on Black men who are more frequently diagnosed with schizophrenia and other psychotic disorders and who face more brutal treatment than other people with such diagnoses. We have adopted a multidisciplinary approach which draws insights from psychiatry, psychology, and sociology and challenges the biologistic interpretation of “mental illness.” We take into account the United States and Britain – two countries with large Black minorities and an established tradition of research on these groups. Among the crucial findings of this study are the facts that racial bias and stereotypes heavily influence the way Black men with a diagnosis of psychotic illness are treated by the psychiatric system, police and prison staff, and that the dominant approach to psychosis masks the connections between racism and mental health.

This study investigated disparities in dual diagnosis (comorbid substance use and depressive/anxiety disorders) among US adults by nativity and racial–ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities.

The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial–ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance use or psychiatric disorder; substance use disorder only; depressive/anxiety disorder only; and dual diagnosis. The data were analyzed using multinomial logistic regression.

The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial–ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments.

The limitations included measures of immigrant status, race–ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities.

This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps.

This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial–ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).

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.

This paper investigates the extent to which disability type contributes to differential evaluation of employees by managers. In particular, the authors examined managerial prejudice against 3 disability diagnoses (i.e. psychiatric, physical disability and pending diagnosis) compared to a control group in a return-to-work scenario.

Working managers (N = 238) were randomly assigned to 1 of 3 scenarios containing medical documentation for a fictional employee that disclosed either the employee's psychiatric disability, physical disability, or a pending diagnosis. The authors also collected a separate sample (N = 42) as a control group that received a version of the medical documentation but contained no information about the disability diagnosis.

Compared with employees without stated disabilities, employees with a psychiatric disability were evaluated as more aggressive toward other employees, less trustworthy and less committed to the organization. Compared to employees with either physical disabilities or pending diagnoses, employees with psychiatric disabilities were rated as less committed to the organization. The authors discuss implications for future research and the trade-offs inherent in disability labeling and disclosure.

The current study extends prior research by examining a broader range of outcomes (i.e. perceived aggressiveness, trustworthiness and commitment) and moving beyond performance evaluations of employees with disabilities. The authors also assess the relative status of a “pending diagnosis” category—a type of disclosure often encountered by managers in many jurisdictions as part of accommodating employees returning to work from medical-related absence.

Mental health assessment in people with learning disability can be a challenging process for clinicians. The more severe the cognitive impairment and level of learning disability, the less likely it is that the clinician can reliably confirm the diagnosis of a psychiatric disorder. Coordinated, multi‐modal interdisciplinary team assessment is the way forward, as it draws together the bio‐psychosocial model of interviewing and mental health care planning. In this article we go through the psychiatric assessment structure and highlight the differences in assessing people with learning disability compared with their peers in the general population. We give special consideration to mental health assessments in emergency settings, and to people with challenging behaviour.

Over the course of their service, veterans are exposed to elevated levels of chronic stress that contribute to a greater prevalence of mental illness than observed in the general population. When mental illness is present, comorbidity is normative. Convergent evidence suggests that co-occurring substance use and mental illness is among the most prevalent forms of comorbidity within veteran samples. The purpose of this paper is to explore issues associated with dual diagnoses among veterans in the USA.

Research on dual diagnoses among veterans was reviewed and consolidated for presentation into three substantive content areas consisting of prevalence, associated conditions, and treatment of dual diagnoses.

Dually diagnosed veterans represent a group at particularly high risk for myriad adverse biopsychosocial and treatment outcomes, including poor health, suicidality, violence or aggressive behavior, arrest, homelessness, and unemployment. A comprehensive strategy has been implemented within the Veterans Health Administration to address dual diagnosis and related problems. Additional research is required to more readily identify co-occurring substance use and mental illness and to refine integrated intervention approaches to minimize burden while improving treatment outcomes for veterans and their families.

The current review includes a wide range of research spanning more than two decades and describing dual diagnosis among combat veterans of all modern eras. Areas in need of further research (e.g. dual diagnosis among female veterans; early detection of psychopathology and fully integrated care among returning veterans) are identified and discussed.

Given the complex association between substance use disorders (SUD), comorbid mental health problems and criminal recidivism in forensic patients, homogenous patient classes can contribute to a refined treatment. This paper aims to construct those classes in forensic patients (N = 286) diagnosed with SUD, unconditionally released between 2004 and 2013 of one of ten Dutch forensic psychiatric centers.

Retrospective data were derived from electronic patient files. Classes were based on the Dutch risk assessment tool, the Historisch Klinisch Toekomst-Revisie (Historical Clinical Future–Revised [HKT-R]) and identified by means of explorative Latent Class Analysis in Latent Gold version 5.1. In a three-step approach, posterior class memberships were related to external variables (i.e. diagnoses, type of drug and type of offence).

Four classes were identified that differ in the risk of recidivism, as well as Axis I and II diagnoses and type of drug consumption.

This study informed on the heterogeneity of forensic patients with SUD and identified four homogenous classes that differ in important variables for the treatment approach. Based on these classes, a more refined treatment approach can be developed. Possible treatment approaches are discussed, but future research is needed to provide evidence.

This study is the first to identify classes within forensic patients with SUD and, therefore, sets the first step to develop a tailored treatment approach based on characteristics informative for treatment.