Post-traumatic stress symptoms and trauma exposure in youth with first episode bipolar disorder

Aims: To examine the prevalence of trauma exposure as well as the rates and effects of post-traumatic stress disorder ( PTSD) in adolescents with bipolar disorder following a first manic episode. Methods: Adolescents (12-18 years) with DSM-IV bipolar I disorder and experiencing their first manic or mixed episode were recruited. Participants underwent structured diagnostic interviews, completed the Trauma Symptom Checklist for Children (TSCC), and were prospectively evaluated using diagnostic, symptomatic and functional assessments over the course of 12 months. Results: Seventy-six adolescents (14.9 +/- 1.7 years) completed the TSCC and 66% ( 50 individuals) reported exposure to traumatic events. Two (3%) subjects met DSM-IV criteria for PTSD, 11 (14%) had post-traumatic stress t-scores >= 65, the threshold for clinically significant symptoms. Subjects with and without post-traumatic stress t-scores >= 65 did not differ in demographic characteristics. When compared by t-score, TSCC subscores of the first episode bipolar adolescents were similar to normative data. Regression models incorporating TSCC subcomponents, did not predict syndromic recovery or recurrence or symptomatic recovery. Conclusions: Rates of PTSD were lower in this sample of bipolar adolescents at the time of their first hospitalization compared with rates in samples of bipolar adults. These differences coupled with the low incidence of PTSD and trauma symptoms in this young sample suggests that bipolar disorder may be a risk factor for the development of PTSD later in the course of illness or following recurrent affective episodes.