Persistent Posttraumatic Stress Disorder Following September 11 in Patients With Bipolar Disorder
J Clin Psychiatry 2006;67(3):394-399
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: We examined the development
of posttraumatic stress disorder (PTSD) following indirect exposure to the September 11, 2001,
terrorist attacks in a cohort at high risk for
adverse trauma-related sequelae as a result of having
Method: Subjects (N = 137) were
participants in the ongoing, naturalistic, longitudinal
study Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) prior to
September 11, 2001. The present study examined
prospectively collected pre-event information about
bipolar disorder and other potential predictors of PTSD, along with assessment of the level of
indirect trauma exposure (i.e., via media) and
peritraumatic distress in the aftermath of
September 11, and their association with 9/11-related,
new-onset PTSD as assessed by a self-report
measure, the Posttraumatic Stress Diagnostic Scale.
Results: Posttrauma assessments were
completed a mean ± SD of 430.6 ± 78.7 days
(range, 0.5-1.5 years) after September 11. Twenty
percent (N = 27) of patients reported development of
new-onset PTSD in response to the September 11 attacks. Rates of PTSD were significantly
associated with the presence of a hypomanic, manic,
or mixed mood state at the time of trauma
(chi2=4.25; p < .05); 62% of patients in these
states developed PTSD. Mania/hypomania remained a significant predictor of PTSD in response to
the September 11 attacks after controlling for
peritraumatic exposure and distress variables,
suggestive of a substantial increase in risk
compared with those in recovery (OR = 17; 95% CI = 2.6
to 115.6; p = .0034).
Conclusions: Rates of persistent
new-onset PTSD among bipolar patients were elevated
in the aftermath of the September 11 attacks. Our findings suggest that the presence of a manic
state may be the most critical risk factor for
adverse sequelae following indirect traumatic exposure
in bipolar individuals.