Clinical and Sociodemographic Characteristics that Affect the Recommendation for Assignment of a Legal Representative in Patients with Bipolar Disorder

Abstract

In this study, we aimed to evaluate the clinical and sociodemographic characteristics of patients with bipolar disorder who had been sent to the Forensic Psychiatry Unit by the court in order to determine factors that affected the decision to appoint a legal representative. The reports of health council, follow-up outpatient, and hospitalization files of a total of 78 patients with bipolar disorder who had been sent to the Department of Forensic Psychiatry Outpatient Clinic of Bakirköy Mental Health and Neurological Diseases Education and Research Hospital between 1st June 2009-31st December 2011 were examined. Patients had been sent by the court in order to determine whether a legal representative was required. Seventy patients meeting enough to sociodemographic and clinical form were separated as appointment group of legal representative or not and decision variables were compared statistically. Forty-six patients (66%) were recommended assignment of a legal representative. In the patients with bipolar disorder for whom a legal representative was recommended, the presence of other first axis comorbidity, the presence of psychotic episodes, delusions of persecution and reference, hallucinations, the total number of manic and mixed episodes, incidence of alcohol and substance abuse, lifetime total number of attacks, and the total number and duration of hospitalizations were found to be significantly higher. The probability of assignment of a legal representative was increased 11-fold by the presence of first axis comorbidity, 1.3-fold by the number of manic episodes, and 2.2-fold by the number of mixed episodes were specified. In the practice of forensic psychiatry, clinicians should focus on the course of the disease, especially the number and frequency of manic or mixed episodes, total number of episodes and hospitalizations, duration of hospitalizations, alcohol and substance use, the presence of episodes accompanied by psychosis with paranoid delusions and hallucinations, and the presence of the other first axis comorbidity in the patient with bipolar disorder for assessment of the decision to appoint a legal representative.