***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study prospect ively followed 103 bipolar patients enrolled in a VA treatment program for 1 year . Mental health service utilization was recorded and aggregated using the VA Cost Distribution Report . We hypothesized that previously reported predictors of disease severity would also predict service utilization , and that several other predictors of service utilization might also be identified . Analyses indicated that only the presence of a major affective episode at clinic intake and a recalled history of childhood physical abuse predicted mental health service utilization . Contrary to expectations , previously reported predictors of disease severity were not significant predictors . Implication s for the study of economic outcome are discussed . In particular , we propose that economic outcome is a complex function of both patient and system factors , rather than simply being passively driven by disease severity BACKGROUND The association between early childhood abuse and the course of illness , including psychiatric comorbidities , in adults with bipolar disorder has not been examined in a predominantly male or veteran population . METHODS As part of the VA Cooperative Study 430 , " Reducing the Efficacy-Effectiveness Gap in Bipolar Disorder , " 330 veterans ( 91 % male ) with bipolar I or II disorder who were enrolled in a 3-year prospect i ve study were examined for baseline data obtained at study entry . Diagnoses were determined by the use of the SCID . A semistructured interview design ed to elicit data about exposure to childhood physical , sexual , or combined abuse was conducted as part of baseline demographic and clinical information . Other reports from this data set have not addressed the issues of childhood adversity . RESULTS  Childhood abuse was reported by 48.3 % of the subjects ( 47.3 % of men ) .  Any abuse ( AA ) was reported by 48.3 % ; sexual abuse without physical abuse ( SA ) was reported by 8 % , physical abuse without sexual abuse ( PA ) by 20.7 % , and both types of abuse ( combined abuse , CA ) by 18.7 % of the male subjects . Female veterans reported more SA ( 27 % ) and less PA ( 6.7 % ) . AA subjects were more likely to have current PTSD and lifetime diagnoses of panic disorder and alcohol use disorders . CA was associated with lower SF-36 Mental scores , higher likelihood of current PTSD and lifetime diagnoses of alcohol use disorders , as well as more lifetime episodes of major depression and higher likelihood of at least one suicide attempt . Younger age at study entry was associated with AA and PA . LIMITATIONS Potential limitations include generalizability beyond the male , veteran population of patients with bipolar disorder and the methodology used to elicit abuse histories . CONCLUSIONS Similar to studies of predominantly female nonveteran sample s , this study extends the finding that a history of childhood abuse acts as a disease course modifier in male veterans with bipolar disorder . Clinicians should routinely seek information regarding abuse and be aware that these patients may be more difficult to treat than bipolar patients who have no abuse histories This study examined whether childhood victimization increases risk for drug abuse  using prospect i ve and retrospective victimization information . Substantiated cases of child abuse/neglect from 1967 to 1971 were matched on gender , age , race , and approximate social class with nonabused/nonneglected children and followed prospect ively into young adulthood . Between 1989 and 1995 , 1,196 participants ( 676 abused/neglected and 520 control ) were administered a 2-hr interview , including measures of self-reported childhood victimization and drug use/abuse ( the National Institute of Mental Health Diagnostic Interview Schedule -- Version III -- Revised ) . Prospect ively , abused/neglected individuals were not at increased risk for drug abuse . In contrast , retrospective self-reports of childhood victimization were associated with robust and significant increases in risk for drug abuse . The relationship between childhood victimization and subsequent drug problems is more complex than originally anticipated BACKGROUND Strong evidence exists for an association between childhood trauma , particularly childhood sexual abuse , and hallucinations in schizophrenia . Hallucinations are also well-documented symptoms in people with bipolar affective disorder . AIMS To investigate the relationship between childhood sexual abuse and other childhood traumas and hallucinations in people with bipolar affective disorder . METHOD A sample of 96 participants was drawn from the Medical Research Council multi-centre trial of cognitive-behavioural therapy for bipolar affective disorder . The trial therapists recorded spontaneous reports of childhood sexual abuse made during the course of therapy . Symptom data were collected by trained research assistants masked to the hypothesis . RESULTS A significant association was found between those reporting general trauma ( n=38 ) and auditory hallucinations . A highly significant association was found between those reporting childhood sexual abuse ( n=15 ) and auditory hallucinations . CONCLUSIONS The relationship between childhood sexual abuse and hallucinations in bipolar disorder warrants further investigation A study was conducted to estimate the accuracy and reliability of  review ers when screening records for relevant trials for a systematic review . A sensitive search of ten electronic bibliographic data bases yielded 22 571 records of potentially relevant trials . Records were allocated to four review ers such that two review ers examined each record and so that identification of trials by each review er could be compared with those identified by each of the other review ers . Agreement between review ers was assessed using Cohen 's kappa statistic . Ascertainment intersection methods were used to estimate the likely number of trials missed by review ers . Full copies of reports were obtained and assessed independently by two research ers for eligibility for the review . Eligible reports formed the ' gold st and ard ' against which an assessment was made about the accuracy of screening by review ers . After screening , 301 of 22 571 records were identified by at least one review er as potentially relevant . Agreement was ' almost perfect ' ( kappa>0.8 ) within two pairs , ' substantial ' ( kappa>0.6 ) within three pairs and ' moderate ' ( kappa>0.4 ) within one pair . Of the 301 records selected , 273 complete reports were available . When pairs of review ers agreed on the potential relevance of records , 81 per cent were eligible ( range 69 to 91 per cent ) . If review ers disagreed , 22 per cent were eligible ( range 12 to 45 per cent ) . Single review ers missed on average 8 per cent of eligible reports ( range 0 to 24 per cent ) , whereas pairs of review ers did not miss any ( range 0 to 1 per cent ) . The use of two review ers to screen records increased the number of r and omized trials identified by an average of 9 per cent ( range 0 to 32 per cent ) . Review ers can reliably identify potentially relevant records when screening thous and s of records for eligibility . Two review ers should screen records for eligibility , whenever possible , in order to maximize ascertainment of relevant trials BACKGROUND AND OBJECTIVE To conduct a pilot study to compare the frequency of errors that accompany single vs. double data extraction , compare the estimate of treatment effect derived from these methods , and compare the time requirements for these methods . METHODS Review ers were r and omized to the role of data extractor or data verifier , and were blind to the study hypothesis . The frequency of errors associated with each method of data extraction was compared using the McNemar test . The data set for each method was used to calculate an efficacy estimate by each method , using st and ard meta-analytic techniques . The time requirement for each method was compared using a paired t-test . RESULTS Single data extraction result ed in more errors than double data extraction ( relative difference : 21.7 % , P = .019 ) . There was no substantial difference between methods in effect estimates for most outcomes . The average time spent for single data extraction  was less than the average time for double data extraction ( relative difference : 36.1 % , P = .003 ) . CONCLUSION In the case that single data extraction is used in systematic review s , review ers and readers need to be mindful of the possibility for more errors and the potential impact these errors may have on effect estimates BACKGROUND Clinical factors related to suicide and suicide attempts have been studied much more extensively in unipolar depression compared with bipolar disorder . We investigated demographic and course-of-illness variables to better underst and the incidence and potential clinical correlates of serious suicide attempts in 648 out patients with bipolar disorder . METHOD Patients with bipolar I or II disorder ( DSM-IV criteria ) diagnosed with structured interviews  were evaluated using self-rated and clinician-rated question naires to assess incidence and correlates of serious suicide attempts prior to study entry .  Clinician prospect i ve ratings of illness severity were compared for patients with and without a history of suicide attempt . RESULTS The 34 % of patients with a history of suicide attempts , compared with those without such a history , had a greater positive family history of drug abuse and suicide ( or attempts ) ; a greater personal history of early traumatic stressors and more stressors both at illness onset and for the most recent episode ; more hospitalizations for depression ; a course of increasing severity of mania ; more Axis I , II , and III comorbidities ; and more time ill on prospect i ve follow-up . In a hierarchical logistic regression , a history of sexual abuse , lack of confidant prior to illness onset , more prior hospitalizations for depression , suicidal thoughts when depressed , and cluster B personality disorder remained significantly associated with a serious suicide attempt . CONCLUSION Our retrospective findings , supplemented by prospect i ve follow-up , indicate that a history of suicide attempts is associated with a more difficult course of bipolar disorder and the occurrence of more psychosocial stressors at many different time domains . Greater attention to recognizing those at highest risk for suicide attempts and therapeutic efforts aim ed at some of the correlates identified here could have an impact on bipolar illness-related morbidity and mortality & NA ; Evidence of the relationship between childhood abuse and pain problems in adulthood has been based on cross‐sectional studies using retrospective self‐reports of childhood victimization . The objective of the current study was to determine whether childhood victimization increases risk for adult pain complaints , using prospect i ve information from documented cases of child abuse and neglect . Using a prospect i ve cohort design , cases of early childhood abuse or neglect documented between 1967 and 1971 ( n=676 ) and demographically matched controls ( n=520 ) were followed into young adulthood . The number of medically explained and unexplained pain complaints reported at follow‐up ( 1989–1995 ) was examined . Assessed prospect ively , physically and sexually abused and neglected individuals were not at risk for increased pain symptoms . The odds of reporting one or more unexplained pain symptoms was not associated with any childhood victimization or specific types ( i.e. sexual abuse , physical abuse , or neglect ) . In contrast , the odds of one or more unexplained pain symptoms was significantly associated with retrospective self‐reports of all specific types of childhood victimization . These findings indicate that the relationship between childhood victimization and pain symptoms in adulthood is more complex than previously thought . The common assumption that medically unexplained pain is of psychological origin should be question ed . Additional research conducting comprehensive physical examinations with victims of childhood abuse and neglect is recommended STUDY OBJECTIVE Studies suggest significant rates of  female sexual assault ( SA ) ; the majority of SAs remain unreported , and few victims receive medical care . The purpose of this study was to determine lifetime prevalence rates of SA in an emergency department population and to assess reporting patterns to police , physicians , and social service agencies . METHODS A verbally administered survey was given to all female patients during 4-hour r and omized periods in an urban Level I trauma center . All English-speaking , noncritically ill women who presented during the study period were eligible . RESULTS Four hundred forty-two women were eligible ; 360 ( 81 % ) women agreed to participate . The lifetime prevalence rate of SA was 39 % ( n=139 ) . Ninety-seven women ( 70 % ) were older than 15 years at the time of SA . Of these 97 SAs occurring in adulthood , 49 ( 52 % ) reported assault by an acquaintance , family member , or friend ; 28 ( 30 % ) by a stranger ; and 17 ( 18 % ) by a partner . Forty-five ( 46 % ) women reported the crime to the police , 42 ( 43 % ) sought medical care , and 23 ( 25 % ) contacted a social service agency . Reporting patterns for victims assaulted by a stranger versus those assaulted by a partner were : reported to police 79 % ( 95 % confidence interval [ CI ] 62 to 95 ) versus 18 % ( 95 % CI 0 to 38 ) ; P < .001 ) , received medical care 70 % ( 95 % CI 46 to 95 ) versus 29 % ( 95 % CI 11 to 48 ; P<.01 ) , contacted a social service agency 30 % ( 95 % CI 5 to 47 ) versus 24 % ( 95 % CI 1 to 46 ; P=.63 ) . CONCLUSION Lifetime female SA rates in ED population s are significant . Fewer than half of SA victims report the assault to the police or seek medical care . Women assaulted by a partner are significantly less likely to report the SA to police or seek medical care BACKGROUND Since recent NIMH Bipolar Disorder Workshops highlighted the dearth of longitudinal and controlled studies of bipolar illness , the Stanley Foundation Bipolar Network ( SFBN ) has recruited a large cohort of patients with bipolar disorder to begin to address these issues . This report describes the demographics and course of illness characteristics of this study population . METHODS The first 261 out patients to be diagnosed by the Structured 
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The prevalence of child sexual abuse was 24 % ( 23 % without outliers ) ; however , such prevalence rate might be underestimated , because many studies restricted definitions to the most severe forms of abuse .
Child sexual abuse was a common experience for both males and females , while it was more frequent for adults than for youths .
Compared to healthy individuals , patients with bipolar disorder reported higher rates of child sexual abuse ; compared to population s with other mental disorders , participants with bipolar disorder reported similar or lower rates of such abuse .
Individuals with bipolar disorder are at risk of having a history of child sexual abuse , although such risk seems to be neither more specific to nor stronger for these individuals , compared to people with other psychiatric disorders