Goldberg Joseph F, Garno Jessica L
Affective Disorders Program, Silver Hill Hospital, 208 Valley Road, New Canaan, CT 06840, USA.
J Psychiatr Res. 2005 Nov;39(6):595-601. doi: 10.1016/j.jpsychires.2004.11.002.
Little is known about the nature and extent of posttraumatic stress disorder (PTSD) in adults with bipolar disorder, particularly in relation to the presence of past childhood or adult forms of abuse, and its impact on course of illness. The authors studied 100 consecutive DSM-IV bipolar patients who were evaluated for childhood physical, sexual and emotional abuse, traumatic events in adulthood, and lifetime PTSD. Adult comorbid PTSD was evident in 24% of subjects and was significantly associated with childhood sexual abuse, adult sexual assault, and adult survival of the suicide, homicide, or accidental death of a close friend or relative. Severe childhood abuse was reported by about half of bipolar patients, but only one-third of abused patients developed PTSD. Risk for PTSD rose in linear fashion to the number of childhood abuse subtypes present. Adult sexual assault was significantly more likely to be associated with PTSD if childhood sexual abuse was present rather than absent. The findings suggest that about one-third of bipolar patients with severe childhood abuse histories, particularly sexual abuse, manifest comorbid adult PTSD. Childhood sexual abuse, as well as severe interpersonal loss, may sensitize individuals who are predisposed to bipolar disorder also to develop eventual PTSD.
关于双相情感障碍成年患者创伤后应激障碍（PTSD）的性质和程度，人们所知甚少，尤其是与过去童年或成年期的虐待形式及其对病程的影响相关的情况。作者对100例连续的DSM-IV双相情感障碍患者进行了研究，评估他们童年时期的身体、性和情感虐待情况、成年期的创伤事件以及终生PTSD。24%的受试者存在成年期共病PTSD，且与童年期性虐待、成年期性侵犯以及亲密朋友或亲属自杀、他杀或意外死亡后的成年期幸存显著相关。约一半的双相情感障碍患者报告有严重童年虐待经历，但只有三分之一的受虐患者患上PTSD。PTSD的风险随着童年期虐待亚型数量的增加呈线性上升。如果存在童年期性虐待，成年期性侵犯与PTSD的关联显著高于不存在童年期性虐待的情况。研究结果表明，约三分之一有严重童年虐待史，尤其是性虐待史的双相情感障碍患者存在成年期共病PTSD。童年期性虐待以及严重的人际丧失，可能会使易患双相情感障碍的个体也更容易最终患上PTSD。
