Comorbid ptsd, bipolar i, and substance use disorder

Abstract

Posttraumatic stress disorder (ptsd) is not always the sole diagnosis seen in patients suffering from it. This chapter will discuss cases that typify the comorbidity of ptsd, bipolar I, and substance use disorder when seen together, and the unique challenges that this constellation of symptoms brings to severe ptsd cases. Both pharmacological and therapeutic implications for treatment are discussed, as well as the possible prognostic indicators seen in such cases. In particular, this chapter will highlight the difficulties that come from A-level recommended treatments for bipolar I disorder being given a D-level rating (harms outweigh benefits) for the treatment of ptsd by the Veterans Affairs/Department of Defense (VA/DOD) guidelines. It will also discuss the risks of polypharmacy, how sobriety can impact ptsd treatment, nontraditional and somatic therapies, and explore potential prognosis and treatment strategies for these comorbid disorders when seen together.