This study compared patients diagnosed with Mixed versus Manic Bipolar disorder across the domains of demographic, symptom, and treatment variables. The sample included 152 patients who were admitted to an acute care psychiatric facility within an index period, whose discharge diagnosis was either Bipolar Disorder, Manic Episode (n = 109) or Bipolar Disorder, Mixed Episode (n = 43). No significant differences were found in age, race, episode number, or length of stay. There was a trend toward females being diagnosed with a Mixed Episode and males a Manic Episode. Group differences were found on physician and nurse symptom ratings, with the manic group receiving higher ratings on resistance, psychosis, and conceptual disorganization and the mixed receiving higher scores on depression and anxiety. On self-report measures, the mixed group endorsed greater severity than did the manic group. The mixed group was more likely to be prescribed antidepressants at discharge; however there were no significant differences across other medication. These differences are discussed.

Debate continues about whether clear nosologic boundaries can be drawn between schizoaffective disorder (SA), schizophrenia (SP), and bipolar disorder (BPD). This study attempted to clarify these boundaries. A retrospective review of the records of adult psychiatric inpatients with DSM-IV diagnoses of SA (n = 96), SP (n = 245), and BPD (n = 203) was conducted. Patients were assessed at admission and discharge using standardized rating scales (completed by physicians and nurses) and self-report inventories. Differential improvement over time also was examined. Significant differences were found for gender, legal status at admission, age, LOS, episode number, and ethnicity. Overall, SA was rated by clinicians as intermediate between SP and BPD, although SA rated themselves as the most severe. SA was similar to SP on positive symptoms, intermediate on negative symptoms, and similar to BPD on mood- and distress-related symptoms. Independent of diagnosis, differences in change scores from admission to discharge were related to severity level at admission. Although several differences were found in symptom severity across domains, no syndrome was identifiable associated with the diagnosis of SA and the diagnosis was unstable over time, thereby bringing into question the validity of SA as a diagnostic entity.

Despite increasing attention given to the high prevalence and effects of abuse in the severely mentally ill, few studies have looked at its effects among males. While both male and female psychiatric patients report greater abuse history than the general population, studies have focused on females alone. The current study compared the effects of abuse history between 271 severely mentally ill males (n = 160) and females (n = 111). The mean age of participants was 33.7 years (SD = 9.73), and included 129 Caucasians, 120 African Americans, 15 Hispanic-Americans, and 7 “Other” (i.e., Asian and native American descent). Primary Axis I diagnoses included Bipolar disorder (23.2%) major depressive disorder (27.7%) schizophrenic disorder (26.6%), substance-related disorders (10.3%), and miscellaneous disorders (12.1%). Each patient completed a comprehensive assessment, including clinician ratings, self-report measures, clinical and structured interviews. Comparisons between genders revealed that females were more likely to report both physical and sexual abuse, and males were more likely to report no history of abuse. In addition, Caucasians were more likely to report abuse than were African Americans, and voluntary patients were more likely to endorse abuse history than those admitted involuntarily. Few gender differences were found in psychological symptoms among males and females. Satisfaction with the home environment was significantly lower for abused than nonabused females. This was not true for males. However, abused psychiatric patients were perceived by the physicians, nurses, and themselves as having greater emotional disturbance than were nonabused patients, regardless of gender. Clinical implications are discussed.

Objectives This article examines agreement between physicians and psychiatric inpatients on the presence of comorbid substance abuse. In addition, inpatients with comorbid substance abuse were compared on demographic and diagnostic-related symptoms with those with a single, non–substance-related disorder. Methods At admission and discharge, 539 patients completed self-report measures of substance use and diagnostic symptoms. Their attending physicians and nurses completed rating scales in the same time frame. In addition, physician discharge diagnoses were examined. Results For 69% of patients there was agreement between patients and physicians for the absence (30.4%) or presence (38.6%) of substance abuse. For 31%, there was disagreement; 10% were those in whom physicians diagnosed substance abuse but patients denied it, and 21% endorsed substance abuse which their physicians did not diagnose. Also, those who were not substance users tended to receive more severe clinician ratings but self-reported fewer symptoms. They also were more likely to be older, have longer lengths of stay, and to have been admitted involuntarily. Conclusions A considerable number of psychiatric inpatients are underdiagnosed for comorbid substance abuse. Multimodal means of assessment would probably enhance the inclusion of such diagnoses. Also, differences in symptoms may suggest differences in treatment regimens.