@article{ref1,
title="Early psychological stressors: Relationship to suicidality and course of bipolar illness",
journal="Clinical Neuroscience Research",
year="2002",
author="Leverich, G.S. and Pérez, S. and Luckenbaugh, D.A. and Post, R.M.",
volume="2",
number="3-4",
pages="161-170",
abstract="Substantial preclinical data support the view that early environmental stress may be associated with long-term changes in brain development and brain chemistry in association with long-lasting alterations in neuroendocrinology, behavior, and vulnerability to acquiring psychoactive drug self-administration. Similarly, a considerable clinical literature has evaluated the possible impact of early and ongoing psychosocial stress in the onset and recurrence of the unipolar and bipolar affective disorders and their comorbidities. In this article we review data on the association of the occurrence of severe environmental stressors in childhood and adolescence and subsequent course of illness in a cohort of more than 600 outpatients with bipolar I or bipolar II disorder studied in the Stanley Foundation Bipolar Network. Self-report of early physical or sexual abuse was used as the primary index of early stressors and a variety of other events were noted, both at illness onset and prior to the most recent affective episode. The early adversities in childhood and adolescence were associated with an earlier onset of bipolar disorder, a more adverse course of illness reported retrospectively and confirmed prospectively, more Axis I, II, and III comorbidities, lack or loss of ongoing social and medical supports, and an increased incidence of serious suicide attempts prior to network entry. These early extreme stressors interacted with a positive family history of affective disorders in relation to an earlier age of onset of bipolar disorder, and there also appeared to be a stressor 'dose' relationship to the incidence of prior suicide attempts. The impact and interaction of these stressors on course of illness, comorbidity, and suicide attempts are discussed in relation to the clinical and preclinical literature and opportunities for early intervention and prevention. © 2002 Published by Elsevier Science B.V.<p /><p>Language: en</p>",
language="en",
issn="1566-2772",
doi="10.1016/S1566-2772(02)00041-5",
url="http://dx.doi.org/10.1016/S1566-2772(02)00041-5"
}