Stress reactivity in bipolar patients and its relation to prior history of disorder.
OBJECTIVE
Two questions were posed: Does stress precipitate episodes of bipolar I disorder, and does sensitivity to stress differ in episodes later in the course of illness compared to early ones?


METHODS
Fifty-two patients with bipolar I disorder were followed longitudinally for up to 2 years; clinical course was monitored, and interview assessments of life events were made every 3 months.


RESULTS
The patients who had episodes of illness during follow-up had experienced significantly more severe stressors and more total stress in the preceding 6 months, and more total stress in the preceding 3 months, than those without episodes. Inconsistent with Post's stress "sensitization" hypothesis, patients with more prior episodes were more likely to have episodes following major stressors, and they relapsed more rapidly.


CONCLUSIONS
Stressors may precipitate episodes of bipolar illness, especially for patients with more prior episodes. Different versions of the stress sensitization model remain to be tested.
Hammen
C
C
Department of Psychology, University of California, Los Angeles, 90095-160, USA. hammen@psych.ucla.edu
Gitlin
M
M
D000328:Adult; D000553:Ambulatory Care; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008960:Models, Psychological; D012008:Recurrence; D016019:Survival Analysis