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Bipolar disorder is a chronic mental illness that has significant morbidity and mortality implications globally. Increasingly, as with many mental health disorders, patients are being identified in primary care settings. In this overview, we discuss screening and case identification, making the case for judicious use of screening tools coupled with follow-up clarifying questions. We review the main modalities of treatment including pharmacother-apy and the evidence for non-pharmacotherapy adjunctive approaches. We discuss recommendations and cautions regarding the use of antidepressants in this population. Finally, we explore the role of new models of care and pharmacogenetic testing. As primary care providers play a critical role in the care of patients with bipolar disorder there are a number of important considerations both in the identification of patients as well as initiating and monitoring treatment.

There is a relative paucity of literature in the field of spirituality among people who have a lived experience of severe mental illness from Australia. Sixteen individuals with a severe mental illness were interviewed on their experiences of spirituality. The three themes that emerged from the data were concepts of spirituality, benefits of intentional spiritual practices and perceived spiritual benefits of recreational pursuits and physical activity. This paper adds to the relatively sparse literature on spirituality among persons with a mental illness in Australia.

The five-minute speech sample is an indirect measure of familial emotional climate, measuring the degree of criticism and/or emotional over-involvement a parent displays while describing a child. Originally developed for parents of adult children with chronic mental illness, the five-minute speech sample has more recently been used among parents of younger children, with inconsistent results. The first aim was to investigate the five-minute speech sample as a measure of parenting perceptions for nonclinical youth by analyzing relations of criticism and emotional over-involvement with self-reported and observed measures of parenting behavior in a diverse community sample of mothers (N = 64) with school-age children (M age = 9.48). Self-reported emotion socialization behaviors and observed parenting practices were correlated with criticism and emotional over-involvement ratings. The second aim was to analyze criticism and emotional over-involvement as mediators in a relationship between a mother’s history of maltreatment and her parenting behaviors. Findings indicated that criticism and emotional over-involvement are related to observed and self-reported parenting behaviors, though emotional over-involvement appears to be an aspect of positive parenting in this youth sample. All subtypes of maltreatment were correlated with significantly less emotionally supportive behaviors, but not with more unsupportive behaviors. Higher levels of emotional over-involvement significantly mediated the relationship between a history of sexual abuse and supportive and unsupportive parenting practices.

Obsessive–compulsive disorder (OCD) is a frequently occurring chronic mental illness involving persistent thoughts, impulses, and mental images that lead to increased anxiety and the urge to preform rituals intended to reduce anxiety. Both obsessions and compulsions can be time consuming and interfere considerably with daily functioning. Once viewed as nearly untreatable, mounting research over the past three decades has since confirmed that symptoms of OCD can significantly improve by use of exposure and response prevention (EX/RP) as an evidence-based treatment. This paper aims to present an argument for why clinical social workers should gain skills to effectively treat OCD with EX/RP. OCD and EX/RP are both described in detail followed by an evaluation of effectiveness of EX/RP and a clinical case example. Implications for social work practice are discussed.

In this paper, I develop a phenomenological description of lived autonomy and describe possible alterations of lived autonomy associated with chronic depression as they relate to specific psychopathological symptoms. I will distinguish between two types of lived autonomy, a pre-reflective type and a reflective type, which differ with respect to the explicitness of the action that is willed into existence; and I will relate these types to the classical distinction between freedom of intentional action and freedom of the will. I will then describe how a chronically depressed person habitually discloses her experiential workspace with an impaired scope of perceivable action-properties, and pre-reflectively values many of these perceived action-properties as demanding or devalues these properties as well as her own abilities and drive to perform the respective actions ('depressive habituality'). These alterations, typically experienced in a passive manner, imply an impairment of both types of lived autonomy. Drawing on first-hand accounts, I will then argue that small islands of lived autonomy, even of the reflective type, are possible if the afflicted identifies with at least some of her 'depressive disabilities' (i.e., her levelled amount of daily activities, her social retreat in certain periods). Lastly, I will compare this manner of life-conduct with the constellation of includence (Inkludenz), as described by Tellenbach, and discuss the limitations of this study.

The ideas outlined in this paper developed from three separate strands of my work as a therapist treating older people. Firstly, I was concerned with reducing the number of patients not benefiting from therapy. In keeping with Pinquart et al.'s (Am J Psychiatry 163:1493–1501, 2006) recent meta-analytic survey concerning the use of psychotherapy and medication, 50% of the depressed patients treated by my team failed to respond adequately. Secondly, the ideas grew out of my attempts to determine why different therapies with older people have often been shown to have equivocal beneficial impacts (Davies and Collerton, J Ment Health 6:335–344, 1997). Thirdly, I was interested in integrating the relevant neuropsychological features, particularly memory, into my therapeutic work. These three strands have led me to propose a pan-theoretical model of distress based on memory functioning and existing information processing perspectives (Teasdale and Barnard, Affect, cognition and change: Remodelling depressive thought, 1993; Power and Dalgleish, Behav Cogn Psychother, 27:129–142, 1996).

The authors describe the impact on training that accompanied an assignment of senior (PGY-4) residents to work one-half day each week for a six month period at a community-based agency concerned with the care of persons with severe and persistent mental illness who were formerly homeless. As the goals and methods of psychiatric training are rethought and adapt to programmatic shifts and economic pressures, new opportunities open up to move treatment and training to the “front lines” in the community where an innovative therapeutic armamentarium for persons with severe and chronic mental illness is developing.

This paper describes and assesses the housing component of The Robert Wood Johnson Foundation Program on Mental Illness, an attempt to test the effects of increasing the supply of affordable, permanent housing available to those with chronic mental illness. Four features of the organization and delivery of independent housing are examined: (1) the structure of the housing development entity; (2) linkages between the housing and mental health systems; (3) targeting of tenant applicants for independent housing; and (4) special issues in providing housing assistance to the homeless mentally ill.

This study explored patterns emerging in videotaped sessions of group psychotherapy with seven outpatients of a large mental health facility. The 22 sessions spanned the 12th to 27th months of the group's existence. Group members had long histories (25–50 years) of symptoms characteristic of schizophrenia. Each session was rated on the Group Environment Scale. One session from a group in its earlier stages was also rated on the same instrument to give some indication of baseline patterns. Analyses of changes across the 15 months were not statistically significant. However, some GES subscales, including Cohesion, Independence, and Self-Discovery, showed relatively high mean levels across the 15-month period. These elevations are discussed as suggesting the codevelopment of orientations that have sometimes been viewed as incompatible and unattainable for schizophrenics. Interpreted clinically, the GES patterns help to elaborate recent findings about the relatively good success of long-term group therapy with such populations. The study, although merely suggestive, illustrates the potential for gleaning solid and clinically useful data from group psychotherapy research.

Materials and methods The objective was to investigate the perceptions of the chronic psychotic patients towards mental illness; to correlate these perceptions with the socio-demographic characteristics, the type and the severity of the psychopathology. For this purpose, 25 patients with chronic mental disorders (aged between 28 and 60) of a Day Center, who partcipated in a full psychotherapeutic and rehabilitative program, completed: 1. a scale for the Assesement of Self-Stigmatisation, 2. a Compliance Questionnaire 3. the Brief Psychiatric Rating Scale, 4. the Global Assessment Scale, and 5. the Calgary Inventory.

The authors designed an intervention to reduce beginning medical students’ stigmatization of people with chronic mental illness (CMI). Pre-clinical medical students visited a state psychiatric facility’s “Living Museum,” a combination patient art studio/display space, as the intervention. During the visit, students interacted with artist-guides who showed their work and discussed their experiences creating art. Students completed a self-assessment survey developed to measure attitudes and feelings toward people with CMI after half of the class visited the Living Museum, constituting a Visit/No-Visit cross-sectional comparison. Students who visited the Living Museum (N=64), as compared with those who did not visit (N=110), endorsed more positive attitudes toward people with CMI. Among the students who visited, however, those who reported having spoken individually with a patient-artist (N=44), paradoxically, indicated less-positive feelings toward people with CMI. An intervention in which pre-clinical medical students visited patient-artist guides in an art-studio setting generally improved students’ attitudes toward people with CMI. Thus, nontraditional psychiatric settings offer a valuable adjunct to more traditional clinical settings to reduce stigma when introducing medical students to the field of psychiatry.

This paper describes the occurrence of chronicity in varying psychiatric illnesses. There is not an unequivocal definition of chronicity, but with the exception of the illnesses that will be described below and that lead directly or indirectly to death from CNS complications of the illness, chronicity will require a duration of a minimum of five years without a significant remission. Chronicity is further differentiated into four different kinds of chronicity: chronic--death, chronic--self-limited, chronic--remission, and chronic--recurrent. The illnesses that may be considered as possibly fulfilling the criteria for chronic will be noted and a method for deciding whether an illness qualifies will be outlined.

More Americans were homeless in 1984 winter than at any time since the Great Depression. The Federal Department of Housing and Urban Development estimates that only 250,000 to 350,000 are homeless nationwide. Whatever the number is, everyone agrees it is growing. There are no reliable national data on the homeless, even though they have always been numerous in American cities. At a time when the accepted solution to the homelessness problem is to establish more shelters, this finding has disturbing implications. The statement that a majority of the homeless are mentally ill does not in itself explain why their number is growing or why a particular individual joins their ranks. Chronic mental illness, even when it is severe enough to impair the ability to function in society, does not by itself cause homelessness, any more than unemployment does. The public debate on homelessness would undoubtedly be enlightened by more rigorous research into the causes of the problem.

1. A survey of the literature and personal communications indicate that the general incidence of brain tumors in hospitalized mental patients is about 2.0 per cent. 2. In a total of 333 tumors found at autopsy by 13 investigators there were 183 (55.0 per cent) unsuspected ante mortem. 3. A survey of the clinical and pathology records at the VA Hospital, St. Cloud, Minn. from 1944 through 1953 disclosed eight (4.3 per cent) brain tumors in 184 autopsies. The autopsies were conducted in 47 per cent of 392 deaths. Three of these tumors were unrecognized ante mortem; one of these was an incidental meningioma with no relation to the mental symptoms or disease course. 4. The likely incidence for remediable symptomatic brain tumors (meningiomas) is about 1:2,000 deaths in hospitals for patients with chronic mental illness.