Saturday, June 2, 2012

Day 9: International Crime research - Bi-Polar Disorder and Violent Crimes Part 2

This is a continuation from: Bipolar Disorder and Violent Crime - New Evidence FromPopulation-Based Longitudinal Studies and Systematic Review Part 1


According to the Psychology Prescribed Text Book: “Understanding Abnormal Behavior” (Sue, Sue and Sue, 2010) “Bipolar Disorder is characterized by Mania, a condition characterized by elevated mood, expansiveness or irritability, often resulting in hyperactivity. It is usually accompanies by depression. Depression and Mania, the two extremes of mood or affect, can be considered the opposite ends of a continuum that extends from deep sadness to wild elation.”

(Two forms of Bipolar Disorder have been classified: Bipolar 1 and Bipolar 2.)


The following Excerpts are taken from the article: International Crime research - Bi-Polar Disorder and Violent Crimes.

(http://archpsyc.jamanetwork.com/article.aspx?volume=67&issue=9&page=931)


Definition of terminology:





Comorbidity: “In psychiatry, psychology and mental health counseling comorbidity refers to the presence of more than one diagnosis occurring in an individual at the same time.” (Wikipedia.org. 2012)




Objectives of the Study: To determine the risk of violent crime in bipolar disorder and to contextualize the findings with a systematic review.


Design: Longitudinal investigations using general population and unaffected sibling control individuals.


Setting : Population-based registers of hospital discharge diagnoses, sociodemographic information, and violent crime in Sweden from January 1, 1973, through December 31, 2004.


Participants: Individuals with 2 or more discharge diagnoses of bipolar disorder (n = 3743), general population controls (n = 37 429), and unaffected full siblings of individuals with bipolar disorder (n = 4059).


Main Outcome Measure: Violent crime (actions resulting in convictions for homicide, assault, robbery, arson, any sexual offense, illegal threats, or intimidation).


Results from Study 1: During follow-up, 314 individuals with bipolar disorder (8.4%) committed violent crime compared with 1312 general population controls (3.5%). The risk was mostly confined to patients with substance abuse comorbidity. The risk increase was minimal in patients without substance abuse comorbidity, which was further attenuated when unaffected full siblings of individuals with bipolar disorder were used as controls.


Results from Study 2: A longitudinal study of 3743 individuals with bipolar disorder has 2 main findings. First, there was an increased risk for violent crime among individuals with bipolar disorder. Most of the excess violent crime was associated with substance abuse comorbidity.


Second, there was an increased risk for violent crime among the unaffected siblings of individuals with bipolar disorder. This finding further weakens the relationship between bipolar disorder per se and violent crime and highlights the contribution of genetic or early environmental factors in families with bipolar disorder.


Bipolar disease severity (measured by the presence of psychotic symptoms) or diagnostic subgroups (manic vs depressive episode) were not associated with a violent crime risk increase in our study. Instead, the association between bipolar disorder and violent crime seemed to be largely mediated by substance abuse comorbidity.


Common familial etiology for bipolar disorder, violent criminality, and substance abuse.


Available data suggest a common familial etiology for bipolar disorder, violent criminality, and substance abuse. First, we found that the risk of violent crime in individuals with bipolar disorder was confined to those with comorbid substance use, and among those with substance abuse comorbidity, the risk was reduced from 6.4 relative to that of general population controls to 2.8 in comparison to sibling controls, indicating that familial effects are important for the association between violent crime and bipolar disorder among individuals with substance abuse. Second, comorbidity between bipolar I disorder and substance misuse is high (60% in the National Comorbidity Survey Replication), and in our data familial effects confounded the association between bipolar disorder and substance abuse (unaffected siblings had twice the rate of substance abuse [4.0%] compared with that of general population controls [1.9%]). Third, related work from Sweden demonstrated a 5-fold increased risk of violent crime in individuals with substance abuse; hence, substance abuse seems to be a likely explanation for increased violence in the unaffected siblings. The finding of shared familial etiology for bipolar disorder, violent criminality, and substance abuse is consistent with at least 2 likely explanations for the increased risk of violence among some patients with bipolar disorder. Bipolar disorder (with a predominantly genetic cause) may lead to substance abuse, which in turn increases the risk for violent crime.


Two implications follow from the role of comorbidity in mediating violence among individuals with bipolar disorder. First, detection is important, and current practice guidelines highlight the fact that comorbidity may be overlooked. Second, substance abuse treatment for individuals with bipolar disorder is likely to reduce the risk for violence and other adverse outcomes (including suicide). More trial evidence is required.


A recent expert consensus statement identified a single trial, that of psychoeducation, for the treatment of comorbidity in patients with bipolar disorder. Other recommendations include the involvement of an addiction psychiatrist and the potential value of dual-diagnosis treatment programs.


What evidence-based recommendations for assessment of risk for violent crime should be made for patients with bipolar disorder, given our findings? Since the risk estimate for bipolar disorder with substance abuse comorbidity is similar to that for substance abuse alone (reported to increase the risk of violence between 6- and 7-fold in a recent review), we suggest that detailed assessment is appropriate for all individuals with substance abuse, irrespective of bipolar diagnosis.


Rates of violent crime and their resolution are similar across western Europe, and assault rates are comparable between Sweden and the United States, suggesting the potential generalizability of our findings. In addition, alcohol sales per capita in Sweden are similar to those in the United States, although comparative information on illegal drug use is limited. Furthermore, Sweden is similar to the United States in terms of an internationally recognized proxy for psychiatric morbidity, namely, age-adjusted disability-adjusted life-years.”



To Summarize – what was found to be the common denominators within the research, was that family dynamics/influence and the use of alcohol and drugs was primarily responsible for Violent Behavior in people diagnosed with Bipolar Disorder as well as for the unaffected siblings of individuals with bipolar disorder.




Self-Forgiveness Part 1:



Bipolar Disorder and Elated Mood




I forgive myself for accepting and allowing a condition such as Bipolar disorder to exist.



I forgive myself for accepting and allowing the Mind to manifest into ‘conditions’, in which I have allowed myself to program and manifest the functioning of the mind into dysfunction, because of a lack of self responsibility within my actions, thoughts and words.


I forgive myself for accepting and allowing the mind to develop and exist as various conditions and dysfunctions because from the beginning I have not taken self responsibility for the mind and have allowed myself to copy the dysfunctions I see in others and have accepted the mind as it exist within others as my parents, siblings and fellow humans – as normal.


I forgive myself for accepting and allowing the mind to become dysfunctional, because I took for granted how the mind simply functions as a program which adapts to what I allow within myself and what I allow myself to become as all the dimensions of the mind – into which I have separated myself into from the physical - as a mind system.


I forgive myself for accepting and allowing myself to abuse myself and others, because I developed conditions of the mind such as Bipolar disorder in which I abdicated responsibility into the mind, based on my starting point of not being self responsible and for not honoring life as myself.


I forgive myself for accepting and allowing the mind to exist in dimensions and for allowing the dimension of mania to exist in which I allow myself to become a different personality.


I forgive myself for accepting and allowing the existence of Mania within me, through which I in moments of irresponsibility would act out in my own self interest not worrying about how my actions affect others, simply so that I may experience an elated mood, which is the addiction to the energy of elated mood, without realizing that I was not acting in awareness of all as myself but simply generating energy through the interaction with my environment, to please me as my mind.


I forgive myself for accepting and allowing myself as a child to get caught up in moments in ‘elated mood’ where I would observe adults and other children pushing their levels of energy due to external stimulus and copying this behavior until I myself became addicted to the desire for this elated mood energy, at the expense of other people and beings on this planet.



I forgive myself for accepting and allowing myself to look for ways to generate this elated mood energy, regardless of who or what the cause of my elation was and regardless of the outflow and consequences in the world of me allowing others to become my slaves for energy.


I forgive myself for accepting and allowing myself to participate only in those aspects of life, where I could participate within myself in energy, completing disregarding the abuse that happens at the opposite end of the polarity of ‘elated mood’, because I was to busy trying to become elated.


I forgive myself for accepting and allowing the design of the polarity system – ‘elated mood’ which has the polarity opposite of ‘sadness/depression’, which is where I would end up experiencing myself if I could not get my energy fix of elated mood.


I forgive myself for accepting and allowing myself to design Bipolar – existent since the beginning of human existence, because I become addicted to elated moods and to find ways to avoid depressed moods, by looking for new ways to up my energy into and as elation and happiness.


I forgive myself for accepting and allowing the existence of the capitalistic system, which was designed to serve my needs to experience elated moods – and over the generations I allowed the compounding effect of the searching for elation, by finding quicker and easier ways to buy my elation by participating with more greed and self-interest in capitalistic system.


I forgive myself for accepting and allowing the existence of the development and compounding of capitalism to serve my needs of elation, whereby I pushed the development of products faster and cheaper for me to have my outcome as elated mood. Within this I did not see and realize, even though it was right there in front of my eyes –that for capitalism to serve my needs of wanting elation faster and for cheaper, more products had to be produced faster for less, which means that more slaves had to work for longer hours with minimal income under stressful life changing situations, to serve my consumerist needs.


I forgive myself for accepting and allowing the destruction of this planet and the beings who live here with me, as capitalism and myself eventually started disregarding and abusing all resources and beings out of the drive for greed and my drive for elation.



I forgive myself for accepting and allowing capitalism to now only exist for human mood elation and in this I gave permission to the abuse of all life, in the name of greed – not realizing that the justification used by capitalists that there exist a ‘market for products’, simply exists because from the beginning I wanted my experience of elation faster and with more intensity, with no regard for the planet and for others and using my own justification of happiness/elation to motivate myself and others so support capitalism and how it is being allowed to destroy and abuse life.


Commitment statements will be placed at the end of the section on Bipolar Disorder.



Part 2: Bipolar Disorder and Expansiveness







Sources:




1. Sue D, Sue DW, Sue S (2010). Understanding Abnormal Behavior. Boston: Wadsworth.



2. (http://archpsyc.jamanetwork.com/article.aspx?volume=67&issue=9&page=931)























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