title: Posttraumatic stress disorder in patients with bipolar disorder: a review of prevalence, correlates, and treatment strategies.
abstract: OBJECTIVE
  In this article, we review the evidence for, and implications of, a high rate of comorbid posttraumatic stress disorder (PTSD) in individuals with bipolar disorder.
  
  
  METHODS
  We reviewed studies providing comorbidity data on patients with bipolar disorder, and also examined the PTSD literature for risk factors and empirically supported treatment options for PTSD.
  
  
  RESULTS
  Studies of bipolar patients have documented elevated rates of PTSD. Based on our review, representing 1214 bipolar patients, the mean prevalence of PTSD in bipolar patients is 16.0% (95% CI: 14-18%), a rate that is roughly double the lifetime prevalence for PTSD in the general population. Risk factors for PTSD that are also characteristic of bipolar samples include the presence of multiple axis I disorders, greater trauma exposure, elevated neuroticism and lower extraversion, and lower social support and socio-economic status.
  
  
  CONCLUSIONS
  These findings are discussed in relation to the cost of PTSD symptoms to the course of bipolar disorder. Pharmacological and cognitive-behavioral treatment options are reviewed, with discussion of modifications to current cognitive-behavioral protocols for addressing PTSD in individuals at risk for mood episodes.
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. mwotto@bu.edu
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
authors.forename: Carol A
authors.initials: CA
authors.lastname: Perlman
authors.forename: Rachel
authors.initials: R
authors.lastname: Wernicke
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Reese
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bauer
authors.forename: Mark H
authors.initials: MH
authors.lastname: Pollack
mesh_terms: D001714:Bipolar Disorder / Q000453:epidemiology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D006801:Humans; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy*