title: Assaultive trauma and illness course in psychotic bipolar disorder: findings from the Suffolk county mental health project.
abstract: OBJECTIVE
  Little is known about the relationship of assaultive trauma to clinical and functional outcome in patients with bipolar disorder.
  
  
  METHODS
  We assessed trauma histories in a cohort of 109 first-admission bipolar patients with psychosis using structured interviews and medical records. Assaultive trauma included rape, physical attacks, and physical threats. Outcome was assessed using standardized ratings.
  
  
  RESULTS
  Forty percent reported a history of assaultive trauma, mostly in childhood (< or =16 years). Exposed patients were more symptomatic at each follow-up than unexposed. Sixteen percent of exposed patients remitted after one episode compared with 38.5% of the non-exposed. Patients exposed as adults were the most symptomatic at 6 months, while patients exposed in childhood were the most symptomatic at 24 months.
  
  
  CONCLUSIONS
  Our findings supported the salient role of trauma history as a risk factor for poor course in severe bipolar disorder. Given the high prevalence of such exposure, clinical awareness in first-admission psychotic bipolar patients is critical.
authors.affiliation: Department of Psychiatry, Columbia University and Anxiety Disorder Clinic, New York State Psychiatric Institute, NY 10032, USA. ny126@columbia.edu
authors.forename: Y
authors.initials: Y
authors.lastname: Neria
authors.forename: E J
authors.initials: EJ
authors.lastname: Bromet
authors.forename: G A
authors.initials: GA
authors.lastname: Carlson
authors.forename: B
authors.initials: B
authors.lastname: Naz
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D010054:Brief Psychiatric Rating Scale; D002649:Child Abuse / Q000523:psychology*; D019548:Crime Victims / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology; D014754:Violence / Q000523:psychology