Anxiety disorders can impair bipolar outcome
Sept. 1, 2004
Multiple comorbid anxiety disorders are fairly common in patients with bipolar disorder and can lead to a poor outcome, say Canadian researchers who found that the type, rather than the number, of anxiety disorders may be a key factor.
"We found that an increasing number of diagnosed anxiety disorders did not predict worse outcomes for our participants. In contrast, it appeared that presence of certain anxiety disorders, generalized anxiety disorder (GAD) and social phobia specifically, were more likely to be associated with negative outcomes on a variety of illness measures," explain Khrista Boylan (St Joseph's Hospital, Hamilton, Ontario) and colleagues
For their study, the researchers used structured clinical interviews to determine the rates of GAD, panic disorder, social phobia, obsessive-compulsive disorder, and post-traumatic stress disorder in 138 patients with bipolar disorder.
The impact of one or more comorbid anxiety disorders on mood symptoms and general functioning was then evaluated over a 3-year period.
Over half (55.8%) of the participants had an anxiety disorder, and close to one third (31.9%) had multiple anxiety disorders.
The results showed that patients with comorbid anxiety disorders had an earlier age at onset of illness, had more depressive symptoms, spent a significantly greater proportion of the year ill, and tended to have lower Global Assessment of Functioning scores than bipolar patients without an anxiety disorder. There was also the tendency for anxiety disorders to be associated with a rapid cycling course of bipolar illness.
The researchers report in the Journal of Clinical Psychiatry that, with regard to negative outcomes, the number of anxiety disorders was found to be less important than the type, with GAD and social phobia having the most negative impact.
"It is obviously important clinically to screen for and treat anxiety disorders in patients with bipolar disorder," Boylan and team conclude.
"Future studies will need to focus on optimal pharmacologic and nonpharmacologic approaches to treating these comorbid conditions as there are few data describing the best management of any anxiety disorder in a patient with bipolar illness."
J Clin Psychiatry 2004; 65: 1106-1113