title: Individuals with bipolar disorder and their relationship with the criminal justice system: a critical review.
abstract: OBJECTIVE
  Bipolar disorder is a severe and prevalent psychiatric disease. Poor outcomes include a high frequency of criminal acts, imprisonments, and repeat offenses. This critical review of the international literature examined several aspects of the complex relationship between individuals with bipolar disorder and the criminal justice system: risk factors for criminal acts, features of bipolar patients' incarceration, and their postrelease trajectories.
  
  
  METHODS
  Publications were obtained from the PubMed and Google Scholar electronic databases by using the following MeSH headings: prison, forensic psychiatry, criminal law, crime, and bipolar disorder.
  
  
  RESULTS
  Among patients with bipolar disorder, the frequency of violent criminal acts is higher than in the general population (odds ratio [OR]=2.8, 95% confidence interval [CI]=1.8-4.3). The frequency is higher among patients with bipolar disorder and a comorbid substance use disorder than among those without either disorder (OR=10.1, CI=5.3-19.2). As a result, the prevalence of bipolar disorder among prisoners is high (2%-7%). In prison, patients' bipolar disorder symptoms can complicate their relationship with prison administrators, leading to an increased risk of multiple incarcerations. Moreover, the risk of suicide increases for these prisoners.
  
  
  CONCLUSIONS
  Criminal acts are common among patients with bipolar disorder and are often associated with problems such as addiction. Thus it is important to improve the diagnosis and treatment of inmates with bipolar disorder.
authors.affiliation: Dr. Fovet, Prof. Vaiva, Dr. Adins, Prof. Thomas, and Dr. Amad are with the Department of Psychiatry, Centre Hospitalier Régional Universitaire de Lille, Université de Lille, Lille, France (e-mail: tfovet@hotmail.fr ). Dr. Geoffroy is with the Institut National de la Santé et de la Recherche Médicale, UMR-S 1144, Paris, and with the Department of Psychiatry, Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris, Paris.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fovet
authors.forename: Pierre Alexis
authors.initials: PA
authors.lastname: Geoffroy
authors.forename: Guillaume
authors.initials: G
authors.lastname: Vaiva
authors.forename: Catherine
authors.initials: C
authors.lastname: Adins
authors.forename: Pierre
authors.initials: P
authors.lastname: Thomas
authors.forename: Ali
authors.initials: A
authors.lastname: Amad
mesh_terms: D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology*; D003415:Crime / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D003416:Criminal Law; D005555:Forensic Psychiatry; D006801:Humans; D011329:Prisoners / Q000331:legislation & jurisprudence* / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States / Q000453:epidemiology