Tuesday, February 1, 2011

Not all mood swings are bipolar disorder

Robert A. Kowatch, MD, PhD, Professor of Psychiatry and Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Erin Monroe, CNS, Clinical Nurse Specialist, Division of Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Sergio V. Delgado, MD, Associate Professor of Psychiatry and Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Mood swings is a popular term that is nonspecific and not part of DSM-IV-TR diagnostic criteria for BD. The complaint of “mood swings” may reflect severe mood lability of pediatric patients with BD. This mood lability is best described by the Kiddie-Mania Rating Scale (K-MRS) developed by Axelson and colleagues as “rapid mood variation with several mood states within a brief period of time which appears internally driven without regard to the circumstance.” On K-MRS mood lability items, children with mania typically score:

  • Moderate—many mood changes throughout the day, can vary from elevated mood to anger to sadness within a few hours; changes in mood are clearly out of proportion to circumstances and cause impairment in functioning

  • Severe—rapid mood swings nearly all of the time, with mood intensity greatly out of proportion to circumstances

  • Extreme—constant, explosive variability in mood, several mood changes occurring within minutes, difficult to identify a particular mood, changes in mood radically out of proportion to circumstances.

Patients with BD typically exhibit what is best described as a “mood cycle”—a pronounced shift in mood and energy from 1 extreme to another. An example of this would be a child who wakes up with extreme silliness, high energy, and intrusive behavior that persists for several hours and then later in the day becomes sad, depressed, and suicidal with no precipitant for either mood cycle. BD patients also will exhibit other symptoms of mania during these mood cycling periods.

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Psychiatry behind bars: Practicing in jails and prisons

Kathryn A. Burns, MD, MPH, Adjunct Clinical Assistant Professor of Psychiatry, Ohio State University, Columbus, OH, Assistant Clinical Professor of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH

Over the last 2 decades mandatory prison sentences, longer prison terms, and more restrictive release policies have lead to a dramatic increase in the number of persons in jails and prisons. Currently, more than 2 million individuals are incarcerated in the United States. Psychiatric illness is over-represented in correctional populations compared with the general population—more than half of all inmates have a mental health diagnosis. Correctional facilities are legally obligated to address the medical and mental health needs of the persons committed to them. As a result, more psychiatrists are practicing in jails and prisons.

This article explains correctional facilities’ obligation to provide for inmates’ mental health needs and describes correctional mental health processes and how psychiatrists can play a role in screening, evaluation, and suicide prevention.

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Two vastly underutilized interventions can improve schizophrenia outcomes

Henry A. Nasrallah, MD


Many psychiatrists would agree that schizophrenia is the most devastating psychiatric brain disease. Its disabling effects result in stigma, unemployment, poverty, loneliness, homelessness, victimization, incarceration, malnutrition, infections, social isolation, ostracism, discrimination, suicide, poor health, medical neglect, and early death

The consequences of schizophrenia are in many ways more malignant than those of cancer, where sympathy, prompt medical care, and preservation of friends and employment are assured. Also, unlike schizophrenia patients, persons with cancer are never hauled to jail, even when a slow-growing brain tumor causes erratic or violent behavior.

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