"We found an increased rate of PTSD and substance use in adolescents with bipolar disorder" said principal investigator Petra H. Steinbuchel, MD, psychiatry resident, Massachusetts General Hospital and Harvard School of Medicine, Boston, Massachusetts. "We also found significantly more substance use disorder in subjects meeting full criteria for PTSD than in cases of sub-threshold PTSD."

For the study, which compared 102 adolescents with bipolar disorder to 108 age-matched controls, Dr. Steinbuchel collaborated with Timothy Wilens, MD, professor of psychiatry, Harvard School of Medicine.

In previous studies, researchers showed that anxiety disorders were often co-morbid disorders in children with bipolar disorder. Therefore, in the current research, Dr. Steinbuchel and Wilens wanted to determine the relationship among bipolar disorder, PTSD, and substance use disorder by comparing adolescents with and without bipolar disorder.

The team performed psychiatric assessments of study subjects using the Kiddie Schedule for Affective Disorders-Epidemiologic Version (KSADS-E). In addition, they assessed substance use with the KSADS Substance Use module in subjects younger than 18 years and the Structured Clinical Interview for the Diagnostic and Statistical Manual IV (SCID) module for Substance Use Disorders in subjects who were 18 years or older.

In the bipolar subjects, 9 (8%) met the full criteria for PTSD and another 9 (8%) met criteria for sub-threshold PTSD. In contrast, 1 control subject (1%) met the full criteria for full PTSD and 2 (2%) met criteria for sub-threshold PTSD.

Among the 18 subjects with bipolar disorder who met the criteria for full or sub-threshold PTSD, 7 (39%) met the criteria for substance use disorder. Within the bipolar group, the investigators documented significantly more substance use in full PTSD than in sub-threshold PTSD (P = .02) or no PTSD (P = .01). Fewer than 10% of controls had substance use disorder, while 30% of those with bipolar disorder had PTSD.

Among the subjects with all 3 conditions, 3 developed bipolar disorder first, then PTSD, and then substance use disorder. Two developed PTSD first, and then bipolar disorder followed by substance abuse. The remaining 2 cases experienced the onset of bipolar disorder and substance abuse at approximately the same time. They then experienced trauma and subsequent PTSD, with worsening substance use.

"In some instances the PTSD precedes the onset of substance use," Dr. Steinbuchel said. "In other cases, the substance use precedes the onset of trauma and may, in fact, place the individual in an at-risk situation, with increased likelihood of trauma, and with an ensuing worsening of substance use."

She urged follow-up studies to determine the course and causal relationship of these conditions.


[Presentation title: Post-Traumatic Stress Disorder and Substance Use Disorder in Bipolar Children. Abstract #C3]

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