title: Clinical outcomes associated with comorbid posttraumatic stress disorder among patients with bipolar disorder.
abstract: To assess clinical outcomes associated with the presence of a lifetime history of comorbid posttraumatic stress disorder in subjects with bipolar disorder.
  
  
  
  This cross-sectional study of 284 subjects with bipolar disorder (DSM-IV) assessed the association between lifetime comorbid posttraumatic stress disorder (DSM-IV) and clinical characteristics. Participants were included from January 2006 to June 2009. We assessed age at onset, number of mood episodes, presence of rapid cycling, first drug use, suicide attempts, hospitalizations, functional impairment, and quality of life. Diagnostic, clinical, and functional assessments were carried out using the Structured Clinical Interview for DSM-IV Axis I Disorders, patient edition (SCID-I/P), the Functioning Assessment Short Test, and the World Health Organization Quality of Life scale. The number of manic episodes as assessed by SCID-I/P was the primary outcome.
  
  
  
  The prevalence of lifetime comorbid posttraumatic stress disorder was 19.7% (56 subjects). Subjects with bipolar disorder and posttraumatic stress disorder had an accelerated course of illness, with a lower age at onset of manic/hypomanic episodes (P = .009) and earlier initiation of illicit drug use (P = .008). In addition, they were more likely to be younger when they received the diagnosis of bipolar disorder (P = .036) and had a higher number of manic/hypomanic episodes (P = .01). Quality of life was worse in all domains among subjects who presented the comorbidity, and rates of functional impairment were higher.
  
  
  
  Comorbid posttraumatic stress disorder was associated with increased morbidity and accelerated illness progression among subjects with bipolar disorder.
authors.affiliation: Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston.|Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Ives C
authors.initials: IC
authors.lastname: Passos
authors.forename: Karen
authors.initials: K
authors.lastname: Jansen
authors.forename: Taiane de A
authors.initials: Tde A
authors.lastname: Cardoso
authors.forename: Gabriela D
authors.initials: GD
authors.lastname: Colpo
authors.forename: Cristian P
authors.initials: CP
authors.lastname: Zeni
authors.forename: Joao
authors.initials: J
authors.lastname: Quevedo
authors.forename: Márcia
authors.initials: M
authors.lastname: Kauer-Sant'Anna
authors.forename: Giovanna
authors.initials: G
authors.lastname: Zunta-Soares
authors.forename: Jair C
authors.initials: JC
authors.lastname: Soares
authors.forename: Flavio
authors.initials: F
authors.lastname: Kapczinski
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D016651:Lithium Carbonate