title: The impact of comorbid posttraumatic stress disorder on bipolar disorder patients.
abstract: BACKGROUND
  Available data regarding posttraumatic stress disorder (PTSD) in bipolar disorder (BD) are scarce and usually from a limited sample size. The present report was carried out using the Brazilian Research Consortium for Bipolar Disorders and aimed to examine whether patients with BD and comorbid PTSD are at an increased risk for worse clinical outcomes.
  
  
  METHODS
  A consecutive sample of bipolar I outpatients from two teaching hospitals in Brazil was recruited. Patients were assessed using the Structured Clinical Interview for DSM-IV, Young Mania Rating Scale, 17-item Hamilton Rating Scale for Depression, and quality of life instrument WHOQOL-BREF. Participants were divided into three groups: a. bipolar patients with PTSD, b. bipolar patients exposed to trauma without PTSD, and c. bipolar patients with no trauma exposure.
  
  
  RESULTS
  Of the 405 patients who consented to participate, 87.7% completed the survey. All three groups were similar in terms of demographic parameters. The group with comorbid PTSD reported worse quality of life, more rapid cycling, higher rates of suicide attempts, and a lower likelihood of staying recovered.
  
  
  CONCLUSIONS
  The cross-sectional design excludes the opportunity to examine causal relationships among trauma, PTSD, and BD.
  
  
  CONCLUSIONS
  The findings indicate that PTSD causes bipolar patients to have a worse outcome, as assessed by their lower likelihood to recover, elevated proportion of rapid cycling periods, increased risk of suicide attempts, and worse quality of life.
authors.affiliation: Teaching Hospital- Psychiatry Service, Universidade Federal da Bahia, Salvador, BA, Brazil. lcq@ufba.br
authors.forename: Lucas C
authors.initials: LC
authors.lastname: Quarantini
authors.forename: Angela
authors.initials: A
authors.lastname: Miranda-Scippa
authors.forename: Fabiana
authors.initials: F
authors.lastname: Nery-Fernandes
authors.forename: Monica
authors.initials: M
authors.lastname: Andrade-Nascimento
authors.forename: Amanda
authors.initials: A
authors.lastname: Galvão-de-Almeida
authors.forename: José L
authors.initials: JL
authors.lastname: Guimarães
authors.forename: Carlos A S
authors.initials: CA
authors.lastname: Teles
authors.forename: Liana R
authors.initials: LR
authors.lastname: Netto
authors.forename: Sidnei B
authors.initials: SB
authors.lastname: Lira
authors.forename: Irismar R
authors.initials: IR
authors.lastname: de Oliveira
authors.forename: Robert M
authors.initials: RM
authors.lastname: Post
authors.forename: Flavio
authors.initials: F
authors.lastname: Kapczinski
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
mesh_terms: D000328:Adult; D000339:Affect; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D001938:Brazil; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008960:Models, Psychological; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult