Canadian Journal Of Psychiatry Research Articles

Lithium use and discontinuation in a health maintenance organization

For decades, lithium has been prescribed to treat bipolar disorder. Its efficacy has been documented by clinical trials and by data from specialized clinics. An issue of considerable interest is the use of lithium in managed care systems. This project examined the use of lithium and its continuity of use by enrollees of a health maintenance organization (HMO). In a 6-year longitudinal cohort study, 1,594 lithium users aged 15 years and older who were enrolled in an HMO were followed from 1986-1991. Data were obtained from automated databases and from medical record review of a random 5% subsample of the group (N = 74). Bipolar disorder was the most frequent morbidity treated. Eighty-four percent (N = 62 or 74) received services from a psychiatrist. Annual prevalence of lithium use increased over the 6-year period from 1.4 to 2.3 persons per thousand HMO members. Duration of use varied widely with some long-term but many short-term users. Discontinuation of treatment was associated with evaluated rates of psychiatric hospitalization and use of psychiatric emergency services. Lithium users were much more likely to receive a variety of other psychotropic drugs than nonusers of the same sex and age. Lithium use in this population was more often sporadic than continuous. Discontinuation of lithium was associated with psychiatric hospitalization. If lithium is to be a cost-effective treatment for bipolar disorder, managed care systems will need to improve adherence to drug treatment regimens.

Thank You to The Canadian Journal of Psychiatry

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Judgments of quality of life of individuals with severe mental disorders: Patient self-report versus provider perspectives

This study was an investigation of judgments regarding quality of life of individuals with severe mental disorders from two different perspectives: patient self-report versus provider. Judgments on several dimensions of quality of life were collected from a convenience sample of 37 schizophrenic patients and their primary clinicians by using the well-known Quality of Life Index of Spitzer et al. and the more recently developed Quality of Life Index-Mental Health. Both indexes capture judgments on a number of dimensions. Patterns of concordance for the patient-provider pairs were tested by using Cohen's kappa and Pearson correlation coefficients. The results suggest that patients' and providers' judgments are more likely to coincide on clinical aspects, such as symptoms and function, than on social aspects. Specifically, there was moderate agreement on symptoms and function, less agreement on physical health, and little to no agreement on social relations and occupational aspects of quality of life. Such differences support the notion that treatment strategies and mental health services should address a wide range of needs reflecting different aspects of quality of life perceived as important by different patients.

Serotonin-dopamine interaction and its relevance to schizophrenia.

The therapeutic success of clozapine and risperidone has focused attention on the interaction between serotonin and dopamine systems as an avenue for superior therapeutics in schizophrenia. The authors review the neurobiological basis for this interaction and its clinical relevance. The authors synthesized information from more than 100 published articles obtained through electronic and bibliography-directed searches. The serotonin system inhibits dopaminergic function at the level of the origin of the dopamine system in the midbrain as well as at the terminal dopaminergic fields in the forebrain. Serotonergic antagonists release the dopamine system from this inhibition. This disinhibition of the dopamine system in the striatum may alleviate neuroleptic-induced extrapyramidal symptoms, and a similar disinhibition in the prefrontal cortex may ameliorate negative symptoms. However, the benefits of combined serotonergic-dopaminergic blockade may be observed in only a narrow dose range and may be lost with doses that produce suprathreshold dopaminergic blockade. Serotonergic modulation of dopaminergic function provides a viable mechanism for enhancing therapeutics in schizophrenia, but much remains unclear. Future research will have to establish the existence of this interaction in humans in vivo, specify the conditions under which it leads to optimal therapeutic benefits, and explore the possibility of using specific serotonergic treatments as flexible adjuncts to typical neuroleptics, rather than the present trend toward using single drugs with combined actions.

Validating Psychiatric Diagnoses

Back to table of contents Previous article Next article ArticleNo AccessValidating Psychiatric DiagnosesRUSSELL GARDNER JR., and DOUGLAS OWEN JONESRUSSELL GARDNER JR.Search for more papers by this author, and DOUGLAS OWEN JONESSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.153.1.141AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Validating Psychiatric Diagnoses." American Journal of Psychiatry, 153(1), p. 141 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByThe Promise of New Drugs for Schizophrenia Treatment1 April 1997 | The Canadian Journal of Psychiatry, Vol. 42, No. 3 Volume 153Issue 1 January 1996Pages 141-141 Metrics PDF download History Published online 1 April 2006 Published in print 1 January 1996

Effectiveness of clozapine and a social learning program for severely disabled psychiatric inpatients.

This study examined the combined effectiveness of clozapine and a comprehensive inpatient psychosocial rehabilitation program on the clinical functioning and aggressive behaviors of patients with chronic schizophrenia. Two groups of 11 subjects each were selected from among patients being treated in the social learning program at Fulton (Mo.) State Hospital. Group 1 subjects were placed on clozapine at various times after the introduction of the program, while group 2 subjects remained on traditional antipsychotics throughout the study period. Group 1 and group 2 subjects were matched on clinical functioning as measured by the Time-Sample Behavioral Checklist (TSBC). For each subject, scores on six TSBC subscales were examined at five time points. Data were analyzed using repeated-measures multiple analysis of variance and univariate analyses of variance. Data on frequency of aggressive behaviors were aggregated into three six-month time periods and were analyzed using Wilcoxon signed-rank tests. Both groups demonstrated significant improvement on several measures. However, the addition of clozapine resulted in accelerated improvement for group 1 subjects, especially in aggressive behaviors. Comprehensive psychosocial treatment programming resulted in significant improvements in clinical functioning for many inpatients. Clozapine may enhance responsiveness to such programming for some patients.

Assessing the needs of siblings following a child abuse death

Child Abuse ReviewVolume 4, Issue 5 p. 382-388 Mental Health NotesFree Access Assessing the needs of siblings following a child abuse death Peter Reder, Peter Reder Consultant Child Psychiatrist in the Child and Family Consultation Centre, Director of the Centre for Relationship Studies, Riverside Mental Health Trust, 1 Wolverton Gardens, London W6 7DQSearch for more papers by this authorGeraldine Fitzpatrick, Geraldine Fitzpatrick Consultant Child Psychiatrist and Clinical Director, Pathfinder Child Mental Health Services, St George's Hospital, LondonSearch for more papers by this author Peter Reder, Peter Reder Consultant Child Psychiatrist in the Child and Family Consultation Centre, Director of the Centre for Relationship Studies, Riverside Mental Health Trust, 1 Wolverton Gardens, London W6 7DQSearch for more papers by this authorGeraldine Fitzpatrick, Geraldine Fitzpatrick Consultant Child Psychiatrist and Clinical Director, Pathfinder Child Mental Health Services, St George's Hospital, LondonSearch for more papers by this author First published: December 1995 https://doi.org/10.1002/car.228Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References Baker, T. (1995). What constitutes reasonable contact? In P. Reder and C. Lucey (Eds), Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. Black, D. (1995). Parents who have killed their partner. In P. Reder and C. Lucey (Eds), Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. Bowlby, J. (1979). On knowing what you are not supposed to know and feeling what you are not supposed to feel. Canadian Journal of Psychiatry, 24, 403– 408. Coleman, R. and Cassell, D. (1995). Parents who misuse drugs and alcohol. In P. Reder and C. Lucey (Eds), Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. d'Orban, P.T. (1979). Women who kill their children. British Journal of Psychiatry, 134, 560– 571. Fitzpatrick, G. (1995). Assessing treatability. In P. Reder and C. Lucey (Eds), Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. Greenland, C. (1987). Preventing CAN Deaths: An International Study of Deaths due to Child Abuse and Neglect. Tavistock, London. Harris Hendricks, J., Black, D. and Kaplan, T. (1993). When Father Kills Mother; Guiding Children Through Trauma and Grief. Routledge, London. James, G. (1994). Study of Working Together ‘Part 8’ Reports. Discussion Report for ACPC Conference 1994. Department of Health, London. Kaplun, D. and Reich, R. (1976). The murdered child and his killers. American Journal of Psychiatry, 133, 809– 813. Reder, P. and Duncan, S. (1995). The meaning of the child. In P. Reder and C. Lucey (Eds), Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. Reder, P., Duncan, S. and Gray, M. (1993). Beyond Blame: Child Abuse Tragedies Revisited. Routledge, London. P. Reder and C. Lucey (Eds) (1995). Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. Resnick, P.J. (1969). Child murder by parents: a psychiatric review of filicide. American Journal of Psychiatry, 126, 325– 334. Resnick, P.J. (1970). Murder of the newborn: a psychiatric review of neonaticide. American Journal of Psychiatry, 126, 1414– 1420. Wilkins, A.J. (1985). Attempted infanticide. British Journal of Psychiatry, 146, 206– 208. Citing Literature Volume4, Issue5Special Issue: FREE ACCESS ISSUE on Fatal Child AbuseDecember 1995Pages 382-388 ReferencesRelatedInformation

Who comes to a voluntary depression screening program?

The purpose of this study was to describe who comes to a voluntary depression screening program by analyzing findings from the 1992 National Depression Screening Day. Survey results from 5,367 adult volunteers at 345 facilities were analyzed. The authors examined the prevalence of depression detected at the screening test and sociodemographic characteristics and treatment history of the respondents. They also estimated the percentage of these individuals who would actually have a diagnosis of major depression (positive predictive value). The main assessment measure was the Zung Self-Rating Depression Scale. Of all participants, 76.6% (N = 4,109) had at least minimal depressive symptoms (score of at least 50 on the Zung depression scale), 53.3% (N = 2,859) had at least moderate symptoms (score of at least 60), and 22.6% (N = 1,214) had severe symptoms (score of at least 70). Few of the depressed respondents were currently in treatment for a mental health problem. The positive predictive value of a screening test diagnosis of depression was between 92.5% and 95.5% when a cutoff score of 60 was used to indicate depression and between 88.7% and 92.3% when a cutoff score of 50 was used. Voluntary screening tests, as exemplified by results from the National Depression Screening Day, provide a good opportunity for identifying previously unidentified and untreated individuals with depression.

Psychopathology among children placed in family foster care

The literature on psychopathology among children in family foster care published in the last 20 years was reviewed to estimate prevalence and types of psychopathology in this population. A comprehensive computerized database was searched for the period 1974 through 1994, with emphasis on recent literature. Available evidence suggests that the prevalence of psychopathology among children in family foster care is higher than would be expected from normative data, even when this population is compared with children who have backgrounds of similar deprivation. As for the types of psychopathology in this population, the only apparent trend is the predominance of externalizing disorders, such as disruptive behavior disorders. A combination of social, psychological, and biological factors may render children in family foster care highly vulnerable to psychopathology.

T2 hyperintensities in bipolar disorder: magnetic resonance imaging comparison and literature meta-analysis

Accumulating evidence suggests a greater number of T2 abnormalities in the brains of patients with bipolar I disorder. The authors sought to evaluate the presence of signal "hyperintensities" in both bipolar I and II subjects and systematically review the existing literature. Magnetic resonance images of the brain were obtained prospectively for 29 patients with bipolar I disorder, 26 patients with bipolar II disorder, and 20 normal comparison subjects. The presence and location of signal hyperintensities in three brain regions (periventricular white matter, subcortical gray matter, and deep white matter) were evaluated. No significant differences were found between groups for the presence of subcortical gray or deep white matter hyperintensities. Periventricular hyperintensities were more common in bipolar I patients (62%) than in bipolar II patients (38%) and normal comparison subjects (30%). Within patient groups, medication use was not significantly different for those with or without the presence of white matter hyperintensities. The literature on bipolar disorder and signal hyperintensities is reviewed. A meta-analysis of the pooled data in the literature on bipolar illness and signal hyperintensities revealed that the odds of having a T2 hyperintensity are significantly greater for bipolar I than for normal comparison subjects. Having bipolar I disorder significantly increases the chance of having white matter changes in the brain. This study suggests that bipolar II patients may be more similar than bipolar I patients to comparison subjects on T2 measures. The possible pathophysiological significance of hyperintensities is discussed.

Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups

Previous epidemiological studies of bulimia nervosa have generated differing estimates of the incidence and prevalence of the disorder. These differences are attributable, in part, to varying definitions of the illness and a range of methodologies. The authors sought to define the prevalence of bulimia nervosa in a nonclinical community sample, examine the clinical significance of DSM-III-R threshold criteria, and examine comorbidity. Subjects across Ontario (N = 8,116) were assessed with a structured interview, the World Health Organization Composite International Diagnostic Interview, with specific questions added for bulimia nervosa. Subjects who met DSM-III-R criteria for bulimia nervosa were compared with those who were missing only the frequency criterion (two or more binge-eating episodes per week for 3 months). In this sample, the lifetime prevalence of bulimia nervosa was 1.1% for female subjects and 0.1% for male subjects. The subjects with full- and partial-syndrome bulimia nervosa showed significant vulnerability for mood and anxiety disorders. Lifetime rates of alcohol dependence were high in the full-syndrome group. Rates of parental psychopathologies were high in both bulimic groups but tended to be higher in the subjects with full-syndrome bulimia nervosa. Both bulimic groups were significantly more likely to experience childhood sexual abuse than a normal female comparison group. This study confirms other prevalence estimates of bulimia nervosa and its comorbid diagnoses from studies that were based on sound methodologies. It also points to the arbitrary aspects of the frequency of binge eating as a diagnostic threshold criterion for the disorder.

Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders

A subpopulation of chronically mentally ill patients, sometimes referred to as "revolving door" patients, are frequently readmitted to psychiatric units. This study examined the relationships among demographic features, diagnostic characteristics, and frequency of hospitalization of patients from four state hospitals. Two semistructured, standardized instruments, the Schedule for Affective Disorders and Schizophrenia and a life events history, were administered to 135 inpatients who met the Research Diagnostic Criteria for schizophrenia (N = 56), schizoaffective disorder (N = 33), unipolar major depressive disorder (N = 23), and bipolar disorder (N = 23). Criminal history was assessed by arrest records. The main outcome measure was the number of hospitalizations. Chi-square and trend test analyses indicated that substance abuse and noncompliance with medication regimens were significantly associated with higher frequencies of hospitalization. A multiple regression model, which included alcohol/drug problems, medication noncompliance, and six sociodemographic and diagnostic variables (age, gender, race, marital status, years of education, and diagnosis) accounted for a significant proportion of the ability to predict frequency of hospitalization. Half of this predictability was due to the relationship of substance abuse and medication noncompliance with number of hospitalizations. Alcohol/drug problems and noncompliance with medication were the most important factors related to frequency of hospitalization. Preventing these behaviors through patient education may reduce rehospitalization rates.

Patient response and resource management: another view of clozapine treatment of schizophrenia

Issues in clozapine treatment were considered in terms of implications for resource management. A critical review of the literature on time course and pattern of response to clozapine was used to address treatment of negative symptoms, late responders, and extent of clinical benefit in ordinary settings. Superior efficacy of clozapine for partial and poor neuroleptic responders is observed in about one-half of the cases. Response is rapid once a therapeutic dose is reached, and the data do not support the proposition that some patients first respond only after 3-12 months of therapy. The cumulative benefit over several months of treatment and the broad range of symptoms involved in response are similar to those for typical neuroleptic drugs, suggesting that clozapine's superiority is based on greater effectiveness rather than a unique profile of treatment effects. Clozapine appears to be effective for secondary, but not primary, negative symptoms. Modal response is moderate, and extensive rehabilitation and clinical services are required to substantially enhance functional outcome. Many more patients merit trials with clozapine. Economic costs and adverse drug effects can be minimized by selecting patients most likely to benefit and discontinuing clozapine treatment when benefit is not observed within 2-4 months. Appropriate patients include 1) those with good responses to typical neuroleptics who experience substantial adverse effects and 2) those whose disorders respond poorly to standard neuroleptics and are defined by psychotic symptoms, thought disorder, and hostility. Treatment of primary negative symptoms is not supported by the current experimental data.

Symptoms of PTSD following recovery of war dead: 13-15-month follow-up.

The authors explored whether individuals who participated in the recovery of war dead were more likely to experience later symptoms of posttraumatic stress disorder (PTSD) than were individuals who were not involved in the recovery of war dead. PTSD symptoms were assessed by questionnaire in men and women who had or had not handled human remains during the Persian Gulf War: 116 men and women who had and 118 who had not handled human remains participated in the study 3-5 months after returning from the war; 55 of the subjects who had and 56 of those who had not handled human remains participated in a follow-up assessment 13-15 months after their return. Subjects who had been involved in the recovery of war dead had significantly higher symptom levels than comparison subjects at both time points. After more than 1 year, individuals who had handled human remains during wartime were at higher risk for PTSD symptoms than those who had not.

Correlates of accuracy in the assessment of psychiatric inpatients' risk of violence

The authors evaluated characteristics of patients whom clinicians accurately assessed as being at high or low risk for violence and patients for whom clinicians overestimated or underestimated the risk. At admission, physicians estimated the probability that each of 226 psychiatric inpatients would physically attack someone during the first week of hospitalization. Nurses rated assaultive behavior in the hospital with the Overt Aggression Scale. Acute symptoms were rated with the Brief Psychiatric Rating Scale. For the group as a whole, assessed levels of risk were substantially related to later physical aggression (sensitivity = 67%, specificity = 69%). Multinomial logit analysis showed that patients with psychotic disorders such as schizophrenia, organic psychotic conditions, and mania were more likely to be accurately assessed by clinicians as being at high risk (true positives) than to be true negatives or false positives. A recent history of violence was associated with higher estimated risk but did not distinguish true positives from false positives. An admission mental status characterized by low levels of hostility, uncooperativeness, and suspiciousness and high levels of depression, guilt, and anxiety differentiated true negative patients from others, but symptom profiles did not differ among true positives, false positives, and false negatives. Clinical judgments emphasizing gender and race/ethnicity were associated with predictive errors: nonwhite and male patients tended to be false positives. While clinicians can accurately classify the potential for violence in the majority of patients at admission, systematic errors characterize inaccurate assessments of the risk. Awareness of these patterns may help improve assessment of the risk of violence in clinical practice.

Platelet serotonin-2A receptors: a potential biological marker for suicidal behavior.

Abnormalities in the serotonergic system have been implicated in suicidal behavior. Higher numbers of serotonin-2 (5-HT2) receptors have been reported in the post-mortem brain of suicide victims. In order to further examine the role of 5-HT2A receptors in suicidal behavior, the authors studied 5-HT2A receptors in platelets of suicidal and nonsuicidal patients as well as normal comparison subjects. 5-HT2A receptor levels were determined by using [125I]LSD as a radioligand in platelets obtained from hospitalized psychiatric patients (N = 131) and nonhospitalized normal comparison subjects (N = 40) during a drug-free baseline period. Patients were diagnosed according to DSM-III-R criteria, and suicidal behavior was identified by using the Hamilton Depression Rating Scale. The mean maximum number of binding sites (Bmax) of platelet 5-HT2A receptors for all suicidal patients was significantly higher than for nonsuicidal patients or normal comparison subjects. This significant difference remained when subgroups of suicidal patients with depression, schizophrenia, schizoaffective disorder, or bipolar illness were compared to the other two subject groups. The higher number of platelet 5-HT2A receptors in suicidal patients was independent of diagnosis. While there was no significant difference in Bmax between patients with serious suicidal ideation and those who made suicidal attempts, both groups had significantly higher Bmax than normal comparison subjects. The observed higher number of platelet 5-HT2A receptors in suicidal patients is independent of diagnosis and appears to be associated with both the brain and the platelets of suicidal patients. These results thus suggest the potential usefulness of platelet 5-HT2A receptors as a biological marker for identifying suicide-prone patients.

The relationship of postdoctoral research training to current research activities of faculty in academic departments of psychiatry

This report describes the postdoctoral research training of faculty in departments of psychiatry and relates research training characteristics to current involvement in research. Data were taken from a survey of 3,107 doctoral-level faculty in departments of psychiatry at 116 U.S. medical schools. The survey instrument gathered information about faculty members' postdoctoral research training and current research activities and elicited recommendations for research training programs. Of the survey respondents, 34.8% had had some form of postdoctoral research training. Most of those had trained in medical schools or intramural programs of the National Institutes of Health and federal institutes on alcoholism, drug abuse, and mental health. Most funding came from the federal government. Postdoctoral research training was significantly related to greater current research involvement across all degree types--M.D., Ph.D., and M.D.-Ph.D. Length of training was related to level of research involvement for M.D.s and Ph.D.s but not M.D.-Ph.D.s. Although most researchers believed their training programs prepared them for independent research, a smaller proportion of M.D.s than M.D.-Ph.D.s or Ph.D.s responded affirmatively to that question. Researchers were more likely than nonresearchers to consider their training adequate. Respondents rated time with mentor, course work in statistics, and length of training as the most important training program features. Both research training and research activities were concentrated in a relatively few institutions. These data show the critical importance of both federal support of research training and postdoctoral research training for subsequent research involvement of psychiatric faculty.

Frontal leukotomy and related psychosurgical procedures in the era before antipsychotics (1935-1954): a historical overview.

This article provides an overview of the history of psychosurgery as a treatment for psychiatric illnesses. The author reviewed articles describing psychosurgery between 1935 and 1954 in order to summarize surgical techniques, clinical indications for surgery, patient selection, complications, and outcome. Patients were operated on for a wide variety of psychiatric illnesses. Initially, a large number of uncontrolled studies reported considerable therapeutic benefit in at least one-third of the patients operated on. Complications with the early surgical techniques included hemorrhage, seizures, infection, and personality changes. Surgical techniques proliferated in hopes of achieving greater therapeutic benefit while minimizing detrimental side effects. As psychosurgery became more widely accepted, its principal supporters began to use it as a routine therapy. A number of uncontrolled and controlled short-term studies supported the efficacy of psychosurgery, but long-term controlled studies showed mixed results. Psychosurgery was promoted as a treatment for patients who had shown little or no response to less drastic therapies. In the context of an era when no efficacious treatments were available for psychosis, its use was understandable. However, its history illustrates the importance of critical evaluation of new treatments in the context of long-term controlled outcome studies, the natural course of specific illnesses, and an understanding of brain physiology.

Course and outcome in bipolar affective disorder: a longitudinal follow- up study

A number of recent studies have questioned whether, despite modern treatment, the natural course of bipolar illness today still involves multiple relapses and impaired psychosocial functioning. This prospective follow-up study examined longitudinal outcome in a large group of inpatients with affective disorders. Fifty-one bipolar manic patients and 49 unipolar depressed patients were interviewed three times: 1) during hospitalization, 2) approximately 2 years after discharge, and 3) approximately 4.5 years after discharge. Subjects were treated under routine conditions and assessed for global adjustment, rehospitalization, and work and social functioning. Only 41% of the bipolar group had a good overall outcome by the time of the 4.5-year follow-up. The bipolar patients had more severe work impairment than the unipolar group. More than one-half of the bipolar patients were rehospitalized at least once during the 4.5-year follow-up period. Outcome for both diagnostic groups improved significantly over time. Many contemporary bipolar patients demonstrate gradual improvement in the first several years after hospitalization. However, a subgroup approaching 60% still experience poor posthospital adjustment in one or more areas of functioning.

Attention deficit hyperactivity disorder in adolescent mania

The purpose of this study was to examine the rate of attention deficit hyperactivity disorder in adolescents with bipolar disorder and to explore the potential effects of comorbid attention deficit hyperactivity disorder on the phenomenology of adolescent bipolar disorder. The authors assessed the rate of attention deficit hyperactivity disorder for adolescents with bipolar disorder who were hospitalized for treatment of acute mania or hypomania. Eight (57%) of 14 adolescent bipolar patients also met DSM-III-R criteria for attention deficit hyperactivity disorder. Patients with both disorders were more likely to be male and Caucasian and to have mixed rather than manic bipolar disorder. Patients with attention deficit hyperactivity disorder had a higher mean total score on the Young Mania Rating Scale than patients with bipolar disorder alone. Although preliminary, these findings may have important implications regarding the potential relationship between bipolar disorder and attention deficit hyperactivity disorder.