Differentiating the symptoms of posttraumatic stress disorder and bipolar disorders in adults: Utilizing a trauma‐informed assessment approach

Cogan, Chelsea M.; Paquet, Caitlin B.; Lee, Jenny Y.; Miller, Katherine E.; Crowley, Matthew D.; Davis, Joanne L.

doi:10.1002/cpp.2504

Cited by 11 publications

(6 citation statements)

References 47 publications

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“…The comorbidity between PTSD and bipolar disorder could be explained by the overlap of some symptoms between these conditions. In particular sleep disturbance, difficulty concentrating, increased risk-taking behavior and irritability are often reported in patients with PTSD and bipolar disorders (Cogan et al, 2021) and they also represent the typical profile of mixed depression (Perugi et al, 2015;Brancati et al, 2019). Therefore a valuable result of this study was to demonstrate that control for irritability, insomnia and poor concentration did not modify the association between bipolar risk score and PTSD.…”

Section: Diagnostic Role Of Post-traumatic Stress Disorder and Childh...mentioning

confidence: 79%

Post-traumatic stress disorder and childhood emotional abuse are markers of subthreshold bipolarity and worse treatment outcome in major depressive disorder

Olgiati

Serretti

2021

International Clinical Psychopharmacology

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Post-traumatic stress disorder (PTSD) and childhood maltreatment (CMT: parental neglect; emotional, physical and sexual abuse) have been linked to bipolar disorder but they are also common in major depressive disorder (MDD). Our objective was to investigate their association with the bipolar spectrum and antidepressant treatment outcome in 482 outpatients with DSM-IV MDD treated in the Combining Medications to Enhance Depression Outcomes trial for 28 weeks Bipolar spectrum score included age of onset <21 years, subthreshold hypomania (a period of elated or irritable mood with at least two concurrent hypomanic symptoms, which did not fulfill DSM criteria for hypomanic/manic episode) and depressive mixed state (DMX). PTSD subjects (n = 107; 22%) had more severe depression (P < 0.0001), work and social impairment (P = 0.0031), comorbid anxiety disorders (P < 0.0001) and increased suicidality (P = 0.0003). Bipolar spectrum score was higher with PTSD comorbidity (P = 0.0063) and childhood emotional abuse (P = 0.0001). PTSD comorbidity was associated with residual suicidality (P = 0.0218) after 6 weeks of antidepressant use whereas childhood emotional abuse [odds ratio (OR), 1.01-2.22], subthreshold hypomania (OR, 1.04-4.09) and DMX (OR, 1.00-4.19) were predictors of mood switch. These results corroborate the role of PTSD and childhood emotional abuse as markers of bipolar spectrum and prognostic factors during antidepressant treatment. Int

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Section: Diagnostic Role Of Post-traumatic Stress Disorder and Childh...mentioning

confidence: 79%

Post-traumatic stress disorder and childhood emotional abuse are markers of subthreshold bipolarity and worse treatment outcome in major depressive disorder

Olgiati

Serretti

2021

International Clinical Psychopharmacology

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“…Of special interest here is the potential overlap between bipolar spectrum disorders and complex post-traumatic stress disorder (CPTSD), which can look very similar upon initial presentation ( 13 ). While ketamine undoubtedly can be helpful for some patients with PTSD or CPTSD ( 14 ), we are also aware of numerous cases where patients were unexpectedly thrown into revisiting traumatic material during their ketamine treatment and were distressed by the experience.…”

Section: Discussionmentioning

confidence: 99%

Ketamine for Bipolar Depression: Biochemical, Psychotherapeutic, and Psychedelic Approaches

Bennett¹,

Yavorsky²,

Bravo³

2022

Front. Psychiatry

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Bipolar disorder (type 1) is a serious and chronic psychiatric illness that can be difficult to treat. Many bipolar patients have refractory depressive episodes. Racemic ketamine, a glutamate modulator with prominent dissociate and psychedelic properties, has been demonstrated to have rapid acting antidepressant and anti-obsessional effects which may be useful for treating the symptoms of bipolar depression. Most of the existing research literature on unipolar and bipolar depression has looked at racemic ketamine in the sub-psychedelic dose range given by infusion as a stand-alone treatment (without concurrent psychotherapy). This article expands on the existing research by articulating three different paradigms for ketamine treatment: biochemical, psychotherapeutic, and psychedelic. The authors use composite clinical vignettes to illustrate different ways of working with ketamine to treat bipolar depression, and discuss a variety of clinical considerations for using ketamine with this population, including route, dose, frequency, chemical mitigators, and adverse events. Note that the conceptual paradigms could be applied to any ketamine treatment, with broad applicability beyond bipolar treatment.

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“…Patients with post-traumatic stress disorder in adulthood may likewise be misdiagnosed with bipolar disorder due to similar features between the two disorders (e.g. increased irritability, poor sleep, and difficulty concentrating; Cogan et al, 2021). Altogether, when combined with the issues of heterogeneous criteria and limited inter-rater reliability, there would seem to be significant challenges in consistently distinguishing PBD from other conditions.…”

Section: Delimitation From Other Disordersmentioning

confidence: 99%

Paediatric bipolar disorder and its controversy

Connors

2022

Acta Neuropsychiatr.

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Objectives Paediatric bipolar disorder – bipolar disorder occurring in prepubertal children – is a diagnosis subject to considerable controversy. Whilst historically considered to be very rare, proponents since the 1990s have argued that mania can present differently in children and, as such, is much more common than previously thought. Such proposals raise questions about the validity of proposed phenotypes and potential risks of iatrogenic harm. Methods I critically examine the construct of paediatric bipolar disorder using Robins and Guze’s (1970) influential criteria for validity of a psychiatric diagnosis. I review, in turn, evidence relating to its clinical description, delimitation from other conditions, follow-up studies, family studies, laboratory studies, and treatment response. Results Across domains, existing research highlights significant challenges establishing the diagnosis. This includes significant heterogeneity in operationalising criteria for children; variable or poor inter-rater reliability; difficulty distinguishing paediatric bipolar disorder from other conditions; large differences in rates of diagnosis between the United States of America and other countries; limited evidence of continuity with adult forms; and a lack of evidence for proposed paediatric phenotypes in children at genetic high-risk of the condition. Laboratory and treatment studies are limited, but also do not provide support for the construct. Conclusions Evidence for the more widespread existence of paediatric bipolar disorder and its various proposed phenotypes remains weak. The ongoing popularity of the diagnosis, most evident in America, may reflect social pressures and broader limitations in psychiatric nosology. The uncertainty around the diagnosis highlights the need for careful longitudinal assessment of children potentially affected.

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Differentiating the symptoms of posttraumatic stress disorder and bipolar disorders in adults: Utilizing a trauma‐informed assessment approach

Cited by 11 publications

References 47 publications

Post-traumatic stress disorder and childhood emotional abuse are markers of subthreshold bipolarity and worse treatment outcome in major depressive disorder

Post-traumatic stress disorder and childhood emotional abuse are markers of subthreshold bipolarity and worse treatment outcome in major depressive disorder

Ketamine for Bipolar Depression: Biochemical, Psychotherapeutic, and Psychedelic Approaches

Paediatric bipolar disorder and its controversy

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