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Bipolar disorder is characterized by the occurrence of one or more manic, hypomanic, or mixed episodes and is typified by periods of mood instability. Pharmacologic treatment of bipolar disorder is associated with significant problems of medication adherence. Cognitive-behavioral therapy is an effective and empirically supported psychosocial treatment for bipolar disorder. Key elements of the CBT intervention include psychoeducation, training in medication adherence, stress management, and cognitive restructuring. In addition to CBT, several other psychosocial treatments have been applied to bipolar disorder. Group treatment has been used for bipolar disorder as a potentially cost-effective method to prevent recurrence. High rates of comorbidity exist among patients with bipolar disorder. At the present time, the evidence for the efficacy of psychosocial interventions for bipolar disorder has never been stronger. The efficacy of psychosocial treatment on specific symptom areas, prominently including the role of anger and anxiety management, needs to be investigated.
The military conflict that occurred between Lebanon and Israel in July and August of 2006 was characterized by the heavy bombardment of specific geographic regions in Israel, resulting in considerable civilian casualties and property damage.
Israeli civilians directly and indirectly exposed to bombardment were compared on exposure to the recent bombardment, trauma history, perceived life threat and peritraumatic dissociation during the recent bombardment, and current post-traumatic stress disorder (PTSD) symptom severity.
Design, Setting, and Participants:
Following the conflict, data were collected by telephone from 317 Israeli residents randomly selected from two towns that were subject to differing levels of exposure to the bombardment.
Main Outcome Measure(s):
Exposure to trauma during the Second Lebanon War, prior trauma exposure, PTSD symptom severity, perceived life threat, and peri-traumatic dissociation.
The residents directly affected by the bombardment (Kiryat Shmona; KS) endorsed more trauma exposure, (p <0.01); more prior trauma, (p <0.01); more life threat, (p <0.01); and greater PTSD symptomatology (12 % of KY participants and 38% of KS participants had probable PTSD), compared to residents in the comparison town (Kfar Yona; KY). Both groups reported a similar degree of peri-event dissociation (KS: M = 7.2 ±3.7; KY: M = 7.3 ±3.0). Perceived life threat mediated the relationship between exposure to bombardment and PTSD symptomatology. Time spent in bomb shelters was not associated with PTSD symptom severity. Prior shelling-related trauma negatively predicted PTSD.
The terror of bombardment is a risk factor for PTSD among civil-ians. Although there is considerable resilience in chronically threatened commu-nities, it is prudent to develop and implement public health approaches to prevent those most distressed during and after attacks from developing PTSD. Because, to a small degree, prior trauma exposure buffers the response to bombardment, interventions should consider leveraging citizens' past successful coping.
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