Bipolar affective disorders are common and frequently debilitating mental illnesses. Diagnostic criteria mean they are defined by the presence of pathological mood elevation, but research shows greater disease burden is inflicted by depressive phases (bipolar depression) both in terms of duration and impact of symptoms. Despite this there is consistent evidence for the underdiagnosis of bipolar depression and its misdiagnosis as a unipolar disorder, with significant subsequent impact on medication management. There is currently less robust evidence for the appropriate pharmacological approach in such individuals than in unipolar depression, and fewer guidelines for clinicians. Despite this there is clear and growing evidence that 'treatment as usual' of depressive symptomatology is ineffective at best, harmful at worst, and that there is little role for the use of antidepressants. Both mood stabilizers and antipsychotics demonstrate efficacy, and whilst there are emerging data on intraclass differences, more research is needed, particularly concerning bipolar II disorder. Present treatment strategies are limited by insufficient large randomized control trials, an inadequate understanding of the neuropathology of bipolar illnesses and a lack of tailored medications. Better clinical training, understanding and recognition of this common condition are essential.

BackgroundThis study aims to identify the neural substrate involved in prosodic pitch processing. Functional magnetic resonance imaging was used to test the premise that prosody pitch processing is primarily subserved by the right cortical hemisphere.Two experimental paradigms were used, firstly pairs of spoken sentences, where the only variation was a single internal phrase pitch change, and secondly, a matched condition utilizing pitch changes within analogous tone-sequence phrases. This removed the potential confounder of lexical evaluation. fMRI images were obtained using these paradigms.ResultsActivation was significantly greater within the right frontal and temporal cortices during the tone-sequence stimuli relative to the sentence stimuli.ConclusionThis study showed that pitch changes, stripped of lexical information, are mainly processed by the right cerebral hemisphere, whilst the processing of analogous, matched, lexical pitch change is preferentially left sided. These findings, showing hemispherical differentiation of processing based on stimulus complexity, are in accord with a 'task dependent' hypothesis of pitch processing.

Purpose -Service user involvement in evaluating provided services is a core NHS concept. However individuals with intellectual disabilities have traditionally often had their voices ignored. There have been attempts to redress this, though much work has been quantitative, and qualitative study has more often explored populations transitioning to more mainstream care and those with milder disabilities. The authors set out to explore the views of individuals with more severe intellectual disabilities who were resident inpatients on what helped or hindered their care. Design/methodology/approach -The paper uses qualitative analysis through semi-structured interviews of eight (three male, five female, mean age 33) resident service users with severe intellectual disabilities. Findings -Sub-categories of staff personality, helpful relationships, and the concept of balanced care emerged under a core category of needing a secure base. Clients were very clearly able to identify and delineate: personal attributes of staff; clinical means of working; and the need to balance support with affording independence and growth. They further noted factors that could help or hinder all of these, and gave nuanced answers on how different personality factors could be utilized in different settings. Originality/value -Little work has qualitatively explored the needs of residential clients with severe intellectual disabilities. The authors' data show that exploring the views of more profoundly disabled and vulnerable individuals is both viable and of significant clinical value. It should aid staff in contemplating the needs of their clients; in seeking their opinions and feedback; and considering that most "styles" of personality and work have attributes that clients can value and appreciate.