Diagnosing bipolar disorder : how can we do it better?

• Accurate diagnosis of bipolar disorder is essential for effective treatment.

• The diagnosis of bipolar disorder is particularly complex, resulting in lengthy delays between first presentation and initiation of appropriate therapy. Inappropriate therapy destabilises the course and outcome of the disease.

• Although the defining features of bipolar disorder are manic or hypomanic episodes, patients typically present for treatment of depression and commonly deny symptoms of mood elevation.

• A correct diagnosis can easily be masked by comorbidities, personality issues and complex phenomenology.

• A diagnosis of bipolar disorder can be assisted by:

   → asking about symptoms of mania or hypomania in every patient presenting with symptoms of depression.

   → recognising mixed states in which manic and depressive symptoms occur simultaneously.

   → identifying the features of bipolar depression that distinguish it from unipolar depression.

• There is a risk of over-diagnosis of bipolar disorder among patients who are histrionic, show abnormal illness behaviour MJA 2006; 184: 459–462 and/or have issues of secondary gain.

Overlap between autistic and schizotypal personality traits is not accounted for by anxiety and depression.

Autism spectrum and schizophrenia spectrum disorders are classified separately in the DSM-5, yet research indicates that these two disorders share overlapping features. The aim of the present study was to examine the overlap between autistic and schizotypal personality traits and whether anxiety and depression act as confounding variables in this relationship within a non-clinical population. One hundred and forty-four adults completed the Autism Spectrum Quotient and the Schizotypal Personality Questionnaire and the Depression Anxiety Stress Scales-21. A number of associations were seen between autistic and schizotypal personality traits. However, negative traits were the only schizotypal feature to uniquely predict global autistic traits, thus highlighting the importance of interpersonal qualities in the overlap of autistic and schizotypal characteristics. The inclusion of anxiety and depression did not alter relationships between autistic and schizotypal traits, indicating that anxiety and depression are not confounders of this relationship. These findings have important implications for the conceptualisation of both disorders.

The relationship between problem gambling and attention deficit hyperactivity disorder

Recent studies indicate that treatment-seeking problem gamblers display elevated rates of ADHD and that adolescents who screen positive for ADHD are more likely to engage in gambling, develop gambling problems, and experience a greater severity in gambling problems. This study aimed to (a) compare the prevalence of ADHD in treatment-seeking problem gamblers to the general population; (b) investigate the relationships between ADHD and problem gambling severity, cluster B personality disorders, motor impulsivity, alcohol use, substance use, gender, and age; and (c) investigate the degree to which these factors moderate the relationship between ADHD and problem gambling severity. Participants included 214 adults (154 males, 58 females, 2 unspecified) who sought treatment for their gambling problems at a specialist gambling agency in Melbourne, Australia. Almost one-quarter (24.9 %) of treatment-seeking problem gamblers screened positively for ADHD, which was significantly higher than the 14 % prevalence in a community sample. ADHD was significantly positively correlated with problem gambling severity, motor impulsivity, and cluster B personality disorders, but was not associated with alcohol and substance use, gender or age. None of the factors significantly moderated the relationship between ADHD and problem gambling severity. These findings suggest that a considerable proportion of treatment-seeking problem gamblers report ADHD and that their clinical profile is complicated by the presence of high impulsivity and cluster B personality disorders. They highlight the need for specialist gambling agencies to develop screening, assessment, and management protocols for co-occurring ADHD to enhance the effectiveness of treatment.

The role of personality in leadership: an application of the five-factor model in the Australian military

This study investigated the relation between the five-factor model (FFM) of personality trait domains and leadership effectiveness. Ninety-nine Australian Army commissioned officers completed the NEO Personality Inventory-Revised (NEO-PI-R; Costa & McCrae, 1992) and were rated by their superior officer on the Australian Army annual leadership effectiveness evaluation schedule. Participants indicated whether they had been selected to attend a leadership promotion course at the Army Command and Staff College, widely regarded within the Army as indicative of an officer's effectiveness. It was hypothesized that leadership effectiveness would be predicted by the personality trait domains of high Conscientiousness, Openness, Agreeableness, and Extraversion and by low Neuroticism. High Conscientiousness and low Extraversion scores predicted high leadership effectiveness and the likelihood of attending the leadership promotion course. High Openness scores also predicted the likelihood of attending the promotion course. The results support the utility of the FFM in exploring the role of personality in leadership effectiveness among military leaders.

Analysis of zinc transporter, hZnT4(Slc30A4), gene expression in a mammary gland disorder leading to reduced zinc secretion into milk

Zinc deficiency, causing impaired growth and development, may have a nutritional or genetic basis. We investigated two cases of inherited zinc deficiency found in breast-fed neonates, caused by low levels of zinc in the maternal milk. This condition is different from acrodermatitis enteropathica but has similarities to the "lethal milk" mouse, where low levels of zinc in the milk of lactating dams leads to zinc deficiency in pups. The mouse disorder has been attributed to a defect in the ZnT4 gene. Little is known about the expression of the human orthologue, hZnT4 (Slc30A4). Sequence analysis of cDNA, real-time PCR and Western blot analysis of hZnT4, carried out on control cells and cells from unrelated mothers of two infants with zinc deficiency, showed no differences. The hZnT4 gene was highly expressed in mouthwash buccal cells compared with lymphoblasts and fibroblasts. The hZnT4 protein did not co-localise with intracellular free zinc pools, suggesting that hZnT4 is not involved in transport of zinc into vesicles destined for secretion into milk. This observation, combined with phenotypic differences between the "lethal milk" mouse and the human disorder, suggests that the "lethal milk" mouse is not the corresponding model for the human zinc deficiency condition.

Re Alex: adolescent gender identity disorder and the family court of Australia

'People with gender identity disorder live with a conviction that their physical anatomy is incompatible with their true gender role. They have an overwhelming desire to live and function in the opposite biological sex' . The manifestation of the disorder in children and adolescents is dominated by secrecy, confusion and shame. The purpose of this article is to promote discussion amongst the legal fraternity of the difficult issues confronting the Family Court of Australia when asked to make decisions with life-altering ramifications for the young and vulnerable.

Personality and responses to appetitive and aversive stimuli: the joint influence of behavioural approach and behavioural inhibition systems

Gray’s reinforcement sensitivity theory (RST) posits two separable neurological systems involved in the regulation of personality and behaviour. The behavioural approach and inhibition systems facilitate the expression of appetitive (impulsive-sensation seeking traits) and aversive motivation (anxiety traits), respectively. Inconsistent findings regarding associations between measures of personality and behavioural responses to appetitive and aversive stimuli has led to a modification of RST including the notion that, rather than separable as first hypothesised, the two systems jointly influence behaviour. The current study was designed to investigate this proposal with an additional focus on the role of reinforcement expectancies. Seventy-eight participants completed two questionnaire measures of BIS/BAS activity (EPQ-R, SPSRQ) and two behavioural measures (Q-TASK, Card Arranging Reward Responsivity Objective Task). Findings were in general consistent with the original separable systems approach, however they also showed that aversive responses were highest in high BAS/high BIS individuals, thus suggesting an interactive account of BIS/BAS processes. Further, stronger positive correlations between self-report BAS traits and behavioural reward responsiveness were found for participants who perceived the task as more rewarding than initially expected. Discussion focuses on the role of reward expectancies and on the issue regarding separable vs. joint BIS/BAS systems.

Reactivity to alcohol-related cues: relationship among cue type, motivational processes, and personality

This study examined the relationship between personality traits implicated in the drinking literature (i.e., sensation seeking and anxiety) and reactivity to 2 different alcohol cues. The opportunity to consume alcohol was manipulated, and differences in urge and affective reactivity were assessed. Gray’s (1987) model of impulsive sensation seeking and anxiety was adopted to investigate relationships between personality and responses to the appetitive (consumption) and aversive (no consumption, nonrewarding) alcohol cues in 40 regular social drinkers. The consumption cue produced increases in appetitive motivation and positive correlations with sensation-seeking traits. The no-consumption cue produced increases in aversive motivation and positive correlations with anxiety-related traits. It was concluded that Gray’s model of impulsive sensation seeking and anxiety may provide a useful framework for examining the personality correlates of cue reactivity to different cues.

Role of peer support and emotional expression on posttraumatic stress disorder in student paramedics

This exploratory study contrasted and tested the predictive value of the reverse buffering hypothesis of social support and the information processing model of posttraumatic stress disorder (PTSD) in an investigation of trauma-related symptomatology (TRS) in a single sample of 42 student paramedics. Participants completed several anonymous self-report measures of PTSD symptomatology, peer social support, and attitude toward emotional expression. Regression-based path analyses did not support either theory of PTSD in this population. A path model of PTSD in student paramedics was subsequently developed, indicating that a direct relationship exists between duty-related trauma exposure, dysfunctional peer social support, and students' negative attitudes toward emotional expression. This new model accounted for 30% of the variance in student paramedics' TRS.

Factors associated with functioning style and coping strategies of familes with a child with an autism spectrum disorder

A survey of parents/caregivers of a child with an autism spectrum disorder (ASD) was conducted to examine the relationship between ASD characteristics, family functioning and coping strategies. Having a child with ASD places considerable stress on the family. Primary caregivers of a child with ASD from a regional and rural area in Victoria, Australia (N = 53) were surveyed concerning their child with ASD, family functioning (adaptability and cohesion), marital satisfaction, self-esteem and coping strategies. Results suggest that these caregivers had healthy self-esteem, although they reported somewhat lower marital happiness, family cohesion and family adaptability than did norm groups. Coping strategies were not significant predictors of these outcome variables. Results highlight the need for support programmes to target family and relationship variables as well as ASD children and their behaviours, in order to sustain the family unit and improve quality of life for parents and caregivers as well as those children.

Stalking, and social and romantic functioning among adolescents and adults with autism spectrum disorder

We examine the nature and predictors of social and romantic functioning in adolescents and adults with ASD. Parental reports were obtained for 25 ASD adolescents and adults (13–36 years), and 38 typical adolescents and adults (13–30 years). The ASD group relied less upon peers and friends for social (OR = 52.16, p < .01) and romantic learning (OR = 38.25, p < .01). Individuals with ASD were more likely to engage in inappropriate courting behaviours (χ² df = 19 = 3168.74, p < .001) and were more likely to focus their attention upon celebrities, strangers, colleagues, and ex-partners (χ2 df = 5 = 2335.40, p < .001), and to pursue their target longer than controls (t = −2.23, df = 18.79, p < .05). These results show that the diagnosis of ASD is pertinent when individuals are prosecuted under stalking legislation in various jurisdictions.

Personality, quality and satisfaction in airline services

This paper examines some issues related to the influence of consumers’ perception of service evaluation according to their personality characteristics. The paper discusses the application of personality traits, including the Jungian personality types, as a possible predictor of perceived satisfaction levels. The existing literature has not fully explored the relationship between airline flights’ service satisfaction levels and consumers’ personality characteristics. A well-known UK leisure airline allowed a survey to be conducted in 1998-2000. The findings suggest that there is a weak correlation between personality types and satisfaction levels, but a stronger relationship between perceptions of quality and satisfaction. The adaptation of the Jungian personality types, for use in the evaluation of leisure airlines’ service attributes, appears to be worthy of further examination.