Mental Health Acts - Perspectives from Mental Health and Law in Ireland and in Portugal.

Mental health legislation is a cornerstone to ensure that individuals with severe mental illness access proper care and treatment. Each country establishes their own legislation. We aimed to compare the Portuguese and Irish Mental Health Acts (MHAs). We reviewed the respective MHA and the literature. While the definition of mental disorder is similar in general, who, where, when and how one can be detained differ. Judges decide on detentions in Portugal, while consultant psychiatrists may do so in Ireland. Community-based compulsory treatment is possible and used in Portugal while it is not possible in Ireland. Pros and cons of each approach are discussed with a reflection on the protection of human rights. Further theoretical and empirical studies comparing systems in different jurisdictions would be helpful to deepen our understanding of the legislation and guide on how to better serve individuals with severe mental illness.

Inter-Rater Reliability between Structured and Non-Structured Interviews Is Fair in Schizophrenia and Bipolar Disorders-A Systematic Review and Meta-Analysis.

We aimed to find agreement between diagnoses obtained through standardized (SDI) and non-standardized diagnostic interviews (NSDI) for schizophrenia and Bipolar Affective Disorder (BD). METHODS: A systematic review with meta-analysis was conducted. Publications from 2007 to 2020 comparing SDI and NSDI diagnoses in adults without neurological disorders were screened in MEDLINE, ISI Web of Science, and SCOPUS, following PROSPERO registration CRD42020187157, PRISMA guidelines, and quality assessment using QUADAS-2. RESULTS: From 54231 entries, 22 studies were analyzed, and 13 were included in the final meta-analysis of kappa agreement using a mixed-effects meta-regression model. A mean kappa of 0.41 (Fair agreement, 95% CI: 0.34 to 0.47) but high heterogeneity (Î2 = 92%) were calculated. Gender, mean age, NSDI setting (Inpatient vs. Outpatient; University vs. Non-university), and SDI informant (Self vs. Professional) were tested as predictors in meta-regression. Only SDI informant was relevant for the explanatory model, leaving 79% unexplained heterogeneity. Egger's test did not indicate significant bias, and QUADAS-2 resulted in "average" data quality. CONCLUSIONS: Most studies using SDIs do not report the original sample size, only the SDI-diagnosed patients. Kappa comparison resulted in high heterogeneity, which may reflect the influence of non-systematic bias in diagnostic processes. Although results were highly heterogeneous, we measured a fair agreement kappa between SDI and NSDI, implying clinicians might operate in scenarios not equivalent to psychiatry trials, where samples are filtered, and there may be more emphasis on maintaining reliability. The present study received no funding.

Updated Meta-Analysis of Epidemiologic Studies of Pediatric Bipolar Disorder.

OBJECTIVE: Research on pediatric bipolar disorder (PBD) has grown substantially in the past 7 years; updating a 2011 meta-analysis of PBD prevalence could improve understanding of factors that influence prevalence. DATA SOURCES: A literature review of papers published in English was updated in 2018 using PubMed and PsycINFO. Search terms included pediatric, child, "bipolar disorder," bipolar, mania, prevalence, epidemiology, community, adolescent, and youth. STUDY SELECTION: Inclusion criteria were (1) youth epidemiologic sample, (2) number of youth with bipolar spectrum disorders reported, and (3) prevalence rates for youth differentiated from prevalence for those over age 21 years (if both included). Of 2,400 articles retrieved, 44 were evaluated and 8 new were included. DATA EXTRACTION: Prevalence rates for each bipolar subtype were recorded as reported; hypothesized moderators (eg, study characteristics, environmental factors) were also coded. RESULTS: Eight additional studies resulted in a total sample of 19 studies, tripling the sample size to N = 56,103 and n = 1,383 with bipolar disorder. Seven studies were from the United States, and 12 were from South America, Central America, or Europe. Weighted average prevalence of bipolar spectrum disorders was 3.9% (95% CI, 2.6%-5.8%). There was significant heterogeneity across studies (Q = 759.82, df = 32, P < .0005). The pooled rate of bipolar I was 0.6% (95% CI, 0.3%-1.2%); these rates were also heterogeneous (Q = 154.27, df = 13, P < .0001). Predictors of higher bipolar spectrum disorder prevalence were the use of broad bipolar criteria (P < .0001), older minimum age (P = .005), and lifetime prevalence (P = .002). Newer studies were associated with lower rates (P < .0001). CONCLUSIONS: The updated meta-analysis confirms that rates of bipolar spectrum disorders are not higher in the United States than in other Western countries, nor are rates increasing over time. Nonstandard diagnostic criteria result in highly variable prevalence rates, as does focusing on narrow definitions of PBD to the exclusion of the full spectrum. Consistent application of validated criteria could help to settle questions regarding PBD prevalence. Studies from non-Western countries are needed to refine understanding of international prevalence and risk factors.

Debate: Looking forward: choose data over opinions to best serve youth with bipolar spectrum disorders - commentary on Parry et al. (2018).

Over the past two decades, research on pediatric bipolar disorder has grown geometrically. The diagnosis of pediatric bipolar disorder was met with enthusiasm, which in healthy doses catalyzed change, and skepticism, which in good measure pushes for rigor. Skepticism led to productive questions about the phenomenology of pediatric bipolar disorder and how best to diagnose and treat it. With regard to prevalence, key questions included whether it was increasing over time, and whether it was limited to the United States. In 2011, we published a meta-analysis addressing the prevalence questions; results indicated that bipolar disorder manifested at statistically indistinguishable rates in youth community samples across the world. In their recent paper, Parry et al. examine the studies included in the 2011 meta-analysis using a qualitative approach. Their opinion piece represents a step backwards; every study has shortcomings, but in focusing on a dozen individual studies, Parry et al. fail to take into account the preponderance of evidence - literally thousands of articles across countries, cohorts and methodologies - that support the existence of bipolar disorder in both prepubescent youth and adolescents. This commentary addresses misperceptions regarding the diagnosis of bipolar disorder in youth, particularly with regard to cross-informant agreement, to present converging data from international sources regarding the onset of bipolar disorder in childhood, and to correct the false claim that pediatric bipolar disorder is controversial. As clinicians and researchers, we have an obligation to do what we can to improve the lives of youth affected by mental illness. Denying the existence of a serious mood disorder will not serve the best interests of young people and will perpetuate the long delays many experience before getting an accurate diagnosis, appropriate treatment, and a fair chance at a good quality of life.

Review and Meta-Analysis of Epidemiologic Studies of Adult Bipolar Disorder.

OBJECTIVE: To test whether rates of bipolar disorder (BD) have changed over time or vary across geographic regions after adjusting for design features meta-analyzing epidemiologic studies reporting BD prevalence in adults worldwide. DATA SOURCES: Searches in PubMed and PsycINFO using the terms (epidemiology OR community OR prevalence) AND (mania OR "bipolar disorder" OR cyclothymi*) AND adult and backward searches from published reviews were conducted. STUDY SELECTION: Eighty-five epidemiologic studies published in English from 1980 onward that reported prevalence rates for BD or mania for subjects ≥ 18 years old were included. DATA EXTRACTION: We coded BD prevalence, method of data collection, diagnostic criteria, year of study, country, and quality of study design and data reporting. Meta-regression tested whether sample characteristics influenced prevalence rates using the metafor package in R. RESULTS: Eighty-five effect sizes, from 44 countries, from studies spanning the years 1980-2012, included 67,373 people with BD. Lifetime prevalence for BD spectrum was 1.02% (95% CI, 0.81%-1.29%). Prevalence was moderated by the inclusion of BD not otherwise specified (P = .009) and by geographic region; rates from Africa and Asia were less than half of those from North and South America. Rates did not change significantly over 3 decades after controlling for design features. CONCLUSIONS: The overall prevalence rate is consistent with historical estimates, but rates vary significantly across studies. Differences in methodology contribute to the perception that rates of BD have increased over time. Rates varied markedly by geographic region, even after controlling for all other predictors. Research using consistent definitions and methods may expose specific factors that confer risk for BD.

Meta-analysis of epidemiologic studies of pediatric bipolar disorder.

OBJECTIVE: Meta-analyze all published epidemiologic studies reporting pediatric mania or bipolar disorder to investigate whether pediatric bipolar disorder is becoming more prevalent and whether rates vary significantly by country. DATA SOURCES: Searches of PubMed and PsycInfo were conducted through the spring of 2010 using the following search terms: child, pediatric, young, adolescent, epidemiology, prevalence, bipolar, mania, suicide, and psychiatric. We also manually reviewed references in recent reviews of epidemiology of bipolar disorder. STUDY SELECTION: All studies reporting rates for mania or hypomania in community epidemiologic samples with participants up to 21 years of age. DATA EXTRACTION: All articles were coded to extract relevant variables. Prevalence rates were calculated from reported number of cases with bipolar disorders, then logit transformed. Twelve studies were included, enrolling 16,222 youths between the ages of 7 and 21 years during a period from 1985 to 2007. Six samples were from the United States; 6 were from other countries (the Netherlands, the United Kingdom, Spain, Mexico, Ireland, and New Zealand). RESULTS: The overall rate of bipolar disorder was 1.8% (95% CI, 1.1%-3.0%). There was no significant difference in the mean rates between US and non-US studies, but the US studies had a wider range of rates. The highest estimates came from studies that used broad definitions and included bipolar disorder not otherwise specified. Year of enrollment was negatively correlated with prevalence (r = -0.04) and remained nonsignificant when controlling for study methodological differences. CONCLUSIONS: Mean rates of bipolar disorder were higher than commonly acknowledged and not significantly different in US compared to non-US samples, nor was there evidence of an increase in rates of bipolar disorder in the community over time. Differences in diagnostic criteria were a main driver of different rates across studies.