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Am J Psychiatry 1997; 154:856-857
Copyright © 1997 by American Psychiatric Association
Stress reactivity in bipolar patients and its relation to prior history of disorder
C Hammen and M Gitlin
Department of Psychology, University of California, Los Angeles, 90095- 160, USA. hammen@psych.ucla.edu
OBJECTIVE: Two questions were posed: Does stress precipitate episodes of
bipolar I disorder, and does sensitivity to stress differ in episodes later
in the course of illness compared to early ones? METHOD: Fifty-two patients
with bipolar I disorder were followed longitudinally for up to 2 years;
clinical course was monitored, and interview assessments of life events
were made every 3 months. RESULTS: The patients who had episodes of illness
during follow-up had experienced significantly more severe stressors and
more total stress in the preceding 6 months, and more total stress in the
preceding 3 months, than those without episodes. Inconsistent with Post's
stress "sensitization" hypothesis, patients with more prior episodes were
more likely to have episodes following major stressors, and they relapsed
more rapidly. CONCLUSIONS: Stressors may precipitate episodes of bipolar
illness, especially for patients with more prior episodes. Different
versions of the stress sensitization model remain to be tested.
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