Original Article Post-traumatic stress symptoms and trauma exposure in youth with first episode bipolar disorder Jeffrey R. Strawn, 1,2 Caleb M. Adler, 1 David E. Fleck, 1 Dennis Hanseman, 1 Danielle K. Maue, 1 Samantha Bitter, 1 Elizabeth M. Kraft, 1 Thomas D. Geracioti, 1 Stephen M. Strakowski 1 and Melissa P. DelBello 1,2 1 Department of Psychiatry, University of Cincinnati, College of Medicine and 2 Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Division of Child & Adolescent Psychiatry, Cincinnati, Ohio, USA Corresponding author: Dr Jeffrey R. Strawn, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0559, Cincinnati, OH 45267-0559, USA. Email: strawnjr@uc.edu Received 10 September 2009; accepted 27 December 2009 Abstract 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. Partici- pants underwent structured diagnos- tic interviews, completed the Trauma Symptom Checklist for Children (TSCC), and were prospectively evaluated using diagnostic, symp- tomatic 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 sig- nificant 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 subcom- ponents, did not predict syndromic recovery or recurrence or sympto- matic recovery. Conclusions: Rates of PTSD were lower in this sample of bipolar adoles- cents at the time of their first hos- pitalization compared with rates in samples of bipolar adults. These dif- ferences coupled with the low inci- dence 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. Key words: abuse, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), trauma. INTRODUCTION Patients with bipolar disorder who experience childhood adversity, trauma and abuse often have a more severe course of illness. 1–3 Not surprisingly, post-traumatic stress disorder (PTSD), a disorder intrinsically linked to the experience of extraordi- nary stress, is highly comorbid in adult bipolar dis- order and is associated with poorer outcomes. 4 Studies of adults with first episode bipolar disorder suggest that 15–21% of these patients meet criteria for PTSD; 5,6 in fact, lifetime PTSD rates may reach 38% in individuals with bipolar disorder. 7 Adoles- cents with bipolar disorder and comorbid PTSD are at increased risk of developing substance use disorders. 8 In addition, individuals with bipolar disorder and significant trauma histories are more prone to rapid cycling and suicide attempts, 4 sug- gesting a more severe illness course for these individuals. Early Intervention in Psychiatry 2010; 4: 169–173 doi:10.1111/j.1751-7893.2010.00173.x © 2010 Blackwell Publishing Asia Pty Ltd 169