ABSTRACT
OBJECTIVE: This study aimed to increase the understanding of the clinical characteristics and utilization of health services among veterans with comorbid bipolar disorder and posttraumatic stress disorder (PTSD). METHODS: A retrospective chart review was conducted that examined the clinical and health service use data of 139 male veterans with bipolar disorder (N=49), PTSD (N=49), or comorbid bipolar disorder and PTSD (N=41) who obtained services over two years from the Department of Veterans Affairs Salt Lake City Health Care System. RESULTS: Compared with patients with bipolar disorder or those with PTSD alone, those with both conditions had significantly higher mean Clinical Global Impression-Severity scores and required more frequent inpatient psychiatric treatment. Patients with both conditions and those with bipolar disorder were significantly less likely to have received psychotherapy and antidepressant pharmacotherapy than patients with PTSD. CONCLUSIONS: Patients with both conditions have a more severe illness course than those with bipolar disorder alone. Psychotherapy and antidepressant pharmacotherapy may be underutilized among patients with comorbid bipolar disorder and PTSD.
Subject(s)
Bipolar Disorder/physiopathology , Comorbidity , Health Services/statistics & numerical data , Stress Disorders, Post-Traumatic/physiopathology , Veterans/psychology , Adult , Humans , Male , Medical Audit , Middle Aged , Retrospective Studies , UtahABSTRACT
Posttraumatic stress disorder (PTSD) is associated with decreased hippocampal volume, but the relationship between trauma and brain morphology in the absence of PTSD is less clear. In this study, measures of brain integrity were determined by estimating gray and white matter regional brain volumes using structural magnetic resonance imaging in six patients with PTSD and in five controls with comparable trauma exposure but without clinical evidence of PTSD. The only statistically significant volume difference between groups was observed multivariately in the white matter of the right temporal lobe (superior temporal gyrus, fusiform gyrus, parahippocampal gyrus, white-matter stem, middle temporal gyrus, and inferior temporal gyrus), although small sample sizes limit the power to detect between-group differences. Both groups showed heterogeneity in cerebral atrophy.
Subject(s)
Combat Disorders/pathology , Stress Disorders, Post-Traumatic/pathology , Stress, Psychological/pathology , Temporal Lobe/pathology , Analysis of Variance , Atrophy , Case-Control Studies , Combat Disorders/complications , Combat Disorders/physiopathology , Humans , Magnetic Resonance Imaging , Male , Matched-Pair Analysis , Middle Aged , Organ Size , Reference Values , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/physiopathology , Stress, Psychological/complications , Stress, Psychological/physiopathology , Temporal Lobe/physiology , Vietnam ConflictABSTRACT
OBJECTIVE: This pilot study was undertaken to exclude the effects of alcohol and other substances on brain morphology in posttraumatic stress disorder. BACKGROUND: Posttraumatic stress disorder and alcohol use are among the conditions associated with decreased hippocampal volume. The possible confounding contribution of alcohol and other substances of abuse to decreased hippocampal volume in posttraumatic stress disorder has not been previously explored directly. METHOD: In this pilot study, magnetic resonance imaging scans of 4 substance naive subjects with combat-related posttraumatic stress disorder and of 4 controls were quantified. RESULTS: Bilateral hippocampal volumes were significantly smaller in posttraumatic stress disorder subjects. No significant differences were found between posttraumatic stress disorder subjects and the comparison group for total brain, gray and white matter, and ventricular volumes. CONCLUSIONS: These findings suggest that posttraumatic stress disorder in the absence of alcohol and other substance abuse may be associated with reduced hippocampal volume. The significance of reduced hippocampal volume in posttraumatic stress disorder is discussed.
