Imaginal exposure exacerbation revisited: Deconstructing patient characteristics associated with worse reactions to the initiation of imaginal exposure in PTSD.

OBJECTIVE: This study examines whether imaginal exposure leads to symptom exacerbation, systematically comparing individuals who received prolonged exposure (PE) to those who received pharmacotherapy. The study also examined whether common clinical features increase the likelihood of symptom exacerbation. METHOD: In 151 men and women with PTSD, we examined rates of reliable exacerbation of PTSD and depression symptoms after initiation of imaginal exposure and compared it to those receiving sertraline. We also examined relationships between exacerbation, treatment outcome, dropout, imaginal distress, and specific clinical features, including co-occurring MDD, multiple co-occurring disorders, childhood sexual abuse as target trauma, and a history of childhood physical or sexual abuse. RESULTS: Symptom exacerbation was not more common in PE compared to sertraline, not associated with higher dropout, or predictive of worse outcome. Those with co-occurring depression or multiple disorders, a target trauma of child sexual abuse, or a history of child abuse reported functionally equivalent peak distress at onset of imaginal as those without these characteristics. These factors did not lead to more exacerbation or worse adherence. CONCLUSION: Exacerbation was not specific to PE and patients with and without symptom worsening showed comparable treatment gains, suggesting symptom exacerbation may reflect a common clinical process.

Posttraumatic stress disorder symptoms, levels of social support, and emotional hiding in returning veterans.

The current study examines the associations among levels of social support, emotional hiding, and screening positive for posttraumatic stress disorder (PTSD) within a sample of 536 Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans. Michigan and Ohio OIF/OEF veterans were contacted to complete a postdeployment mental health screening questionnaire developed as part of the Department of Veterans Affairs Ann Arbor Healthcare System's Serving Returning Veterans Mental Health Program. Approximately 30% of veterans screened positive for PTSD. All sources of social support, as well as emotional hiding, were significantly associated with screening positive for PTSD. Each unit increase of emotional hiding from spouses or significant others, friends, and family was associated with a 32% to 44% increase in odds of screening positive for PTSD. Additional research is needed to examine constructs related to social support and PTSD, such as emotional hiding, in order to identify areas for intervention.

Sex differences in pediatric bipolar disorder.

OBJECTIVE: To explore sex differences in pediatric bipolar disorder in terms of subtype and severity of depressive and manic symptomatology. METHOD: Participants were 760 youth (aged 5-17 years) and their legal guardians. Participants were part of a larger outpatient assessment protocol enriched for bipolar disorder. Youth were assessed for DSM-IV diagnoses using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version. Their presenting mood state was determined using the Young Mania Rating Scale and the Children's Depression Rating Scale-Revised. The study was conducted from January 1996 to February 2003. RESULTS: 387 youth (51%) met DSM-IV criteria for diagnoses of bipolar spectrum disorders. Results showed no sex differences in rates of bipolar spectrum disorders or any of the bipolar subtypes. Sex differences were found with regard to presenting mood states: boys presented with higher rates of manic mood, and girls presented with higher rates of depressed mood. Older children were also more likely than younger children to exhibit higher levels of depressed mood. There were no age differences in levels of manic mood. CONCLUSION: This study highlights how bipolar disorder can manifest itself differently among girls and boys despite equivalent rates of diagnosis. It is important for clinicians to consider the full range of mood states in order to accurately diagnose and treat children. Future research is needed to assess the roles that genetics, puberty, cognitive styles, and environmental factors play in the expression of mania and depression in girls and boys over the course of their development.