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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, 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.

The purpose of this paper is to establish the effectiveness of self-management training as an intervention for people using secondary mental health services.

A self-management and peer support intervention was developed and delivered by secondary mental health service users to 262 people with psychiatric diagnoses living in the community. Data on wellbeing and health-promoting behaviour were collected at three time points (baseline, six, and 12 months).

Participants reported significant improvements in wellbeing and health-promoting lifestyle six and 12 months after self-management training. Peer-led self-management shows potential to improve long-term health outcomes for people with psychiatric diagnoses.

Due to the lack of a control group, the positive changes cannot definitively be attributed to the intervention. Other limitations were reliance on self-report measures, and the varying numbers of completers at three time points. These issues will be addressed in future studies.

The evaluation demonstrated the effectiveness of self-management training for people with psychiatric diagnoses, suggesting self-management training may bring significant wellbeing gains for this group.

This study represents a first step in the implementation of self-management approaches into mental health services. It demonstrates the feasibility of people with psychiatric diagnoses developing and delivering an effective intervention that complements existing services.

This is the first study to investigate the effectiveness of a self-management training programme developed and delivered by mental health service users in the UK.

As the use of drugs and alcohol by clients accessing mental health services becomes increasingly common, members of staff working within psychiatric inpatient areas often encounter drug and alcohol misuse among their client group. The safe and effective management of this issue has become a priority for many inpatient services. This paper outlines a policy for the management of substance misuse on psychiatric inpatient wards developed by Manchester Mental Health and Social Care Trust. The fundamental principles underpinning the policy are highlighted, and the key sections of the policy are described. There is a detailed description of how the policy has been applied in practice by members of staff working on inpatient wards, with clinical examples being presented.

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.

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.

The purpose of this paper is to describe the development and delivery of a self‐management and peer support intervention for people with severe mental health diagnoses.

There was a gap in the provision of a self‐management intervention designed and delivered by people with psychiatric diagnoses. In total, 24 people with the experience of severe mental ill‐health took part in developing the model and course materials for a new self‐management intervention. A three‐stage intervention was designed: two‐day training, six follow‐up sessions, and on‐going peer support.

Between 2009 and 2012, over six hundred participants across Wales were trained. In total, 35 of the new courses and 27 of the Bipolar UK courses have been delivered. Currently, 15 peer support groups are still meeting regularly and many people are receiving on‐going support. At present, the effectiveness of the intervention is being evaluated; data are being collected at baseline, and at six and 12‐month follow‐up.

Most self‐management strategies developed in the past have been focused on physical health conditions and developed and delivered by clinicians. This new self‐management intervention is based on the needs and experiences of the target beneficiaries. It was developed and is being delivered by people who have a psychiatric diagnosis, and have come through the training themselves.

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.

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).

The sequence of stress, distress and somatization has occupied much of the late twentieth-century psychological research. The anatomy of stress can be viewed from interactional and hybrid theories that suggest that the individual relates with the surroundings by buffering the harmful effects of stressors. These acts or reactions are called coping strategies and are designed as protection from the stressors and adaptation to them. Failure to successfully adapt to stressors results in psychological distress. In some individuals, elevated levels of distress and failed coping are expressed in physical symptoms, rather than through feelings, words, or actions. Such “somatization” defends against the awareness of the psychological distress, as demonstrated in the psychosocial literature. The progression of behavior resulting from somatic distress moves from a private domain into the public arena, involving an elaborate medicalization process, is however less clear in sociological discourse. The invocation of a medical diagnosis to communicate physical discomfort by way of repeated use of health care services poses a major medical, social and economic problem. The goal of this paper is to clarify this connection by investigating the relevant literature in the area of women with breast cancer. This manuscript focuses on the relationship of psychological stress, the stress response of distress, and the preoccupation with one’s body, and proposes a new theoretical construct.