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David Baxter

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Anxiety disorders can impair bipolar outcome
Sept. 1, 2004
Psychiatry Matters

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
 

Andy

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Does anyone know or has anyone heard differently from this article if this is still the case here. I mean since it's from 5 years back, is it possible there has been different findings?

Sorry, I know I ask a lot of stupid questions, they are important to me though.

Please and thanks.
 

David Baxter

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I don't know. I can't say I've seen any replications of the findsings or followup studies.

Based on what I see clinically, my guess is that many patients with bipolar disorder have some sort of anxiety-based issues, for example OCD tendencies. Does that make for a negative prognosis? I would say no, as long as those auxiliary issues are recognized, identified, and treated.
 

Andy

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That just freaks me out a little because I am diagnosed bipolar,GAD, and was diagnosed with social phobia before the AvPD. Is there anything else that can add to my struggles of getting better...(that's rhetorical.) Frustrating.
 

David Baxter

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That just freaks me out a little because I am diagnosed bipolar,GAD, and was diagnosed with social phobia before the AvPD.

Did you read this part?

Based on what I see clinically, my guess is that many patients with bipolar disorder have some sort of anxiety-based issues, for example OCD tendencies. Does that make for a negative prognosis? I would say no, as long as those auxiliary issues are recognized, identified, and treated.

You are already being treated for your anxiety issues so it's not like it's "situation: hopeless".

It's like having more than one physical health condition. Suppose you have, for example high blood pressure plus a thyroid disorder. Does that mean you have a negative prognosis because you have more than one condition requiring treatment? No, because both are treatable conditions.
 

Andy

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I did read that. lol I'm sorry I have to read a lot of things over and over before they actually sink in, if they do at all. Apparently I read it the once but, it didn't stick.

I understand what your saying about it not having to be a hopeless situation. Just with treatments not working so well anymore( on me personally) it's hard to look things with hope or patience anymore.
 

David Baxter

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Unfortunately, it can be very difficult to find the right combination of medications to effectively treat bipolar disorder. I understand why you feel frustrated and discouraged, but don't give up hope. Keep working with your doctor and making sure s/he has all the information necessary, e.g., side-effects, symptoms not getting better, symptoms getting worse, new szymptoms emerging, etc. As team, eventually you'll get there.
 

Andy

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Unfortunately, it can be very difficult to find the right combination of medications to effectively treat bipolar disorder. I understand why you feel frustrated and discouraged, but don't give up hope. Keep working with your doctor and making sure s/he has all the information necessary, e.g., side-effects, symptoms not getting better, symptoms getting worse, new szymptoms emerging, etc. As team, eventually you'll get there.
Thank-you. I try to tell my psychiatrist everything with the little time I have with him (a busy guy).
I just feel like all the years are going by so fast, I don't want to be on my death bed finally feeling happy. It's just hard to keep up with "hope" after awhile.
I do know that "hope" is the only thing that will keep me going forward. I use to be able to see the positives in things that sucked, I can't even do that anymore. Well, for others I can. It just seems impossible to find any when I have been this cruddy for this long.:fool:
 

David Baxter

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Thank-you. I try to tell my psychiatrist everything with the little time I have with him (a busy guy).

I often advise clients to make a list and keep adding to it between apointments so when they do get to see the psychiatrist they can just hand it to him/her.

I just feel like all the years are going by so fast

Believe me, we all feel like that!

I don't want to be on my death bed finally feeling happy. It's just hard to keep up with "hope" after awhile.

Yes. That's where "grit and determination" comes in.

I do know that "hope" is the only thing that will keep me going forward. I use to be able to see the positives in things that sucked, I can't even do that anymore. Well, for others I can. It just seems impossible to find any when I have been this cruddy for this long.:fool:

Again, as I often say to clients, at those times when you find it hard to maintain hope, hang on to the hope and faith that others have for you.
 

Andy

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...so when they do get to see the psychiatrist...

...at those times when you find it hard to maintain hope, hang on to the hope and faith that others have for you.

Is that where Ozzy goes? ;) I have written things down before, I find it just piles up because he talks about some of the things (I'm guessing, what he deems important) and says we will talk about the rest next time, by the time next time comes around I have another list. Now I write it down and when I am in the waiting room I decide what's really important and narrow it down, but again that doesn't always happen because it's not always easy to cut in. I'm normally (unless I am ragy) like a mouse, and I am scared to death that if I raise my voice I will feel the consequences.


What if others don't have any of that hope and faith in you?

I'm sorry I don't mean to sound like I am constantly going "yeah but..." I am hearing what your saying and I do know that it's all good and true, I'm just not feeling it.
 

David Baxter

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Is that where Ozzy goes? ;) I have written things down before, I find it just piles up because he talks about some of the things (I'm guessing, what he deems important) and says we will talk about the rest next time, by the time next time comes around I have another list. Now I write it down and when I am in the waiting room I decide what's really important and narrow it down, but again that doesn't always happen because it's not always easy to cut in. I'm normally (unless I am ragy) like a mouse, and I am scared to death that if I raise my voice I will feel the consequences.

The important thing is that he gets the information - uncensored if possible. Don't leave out things because you think it's unimportant - it may be a critical clue. And just because you don't get to discuss everything on the list doesn't mean it's not helpful. I review my notes and notes clients have given me in between sessions, or at the start of the next.

What if others don't have any of that hope and faith in you?

I doubt that's true. I believe you mentioned your father previously. And there are people here who have hope and faith in you...

I'm sorry I don't mean to sound like I am constantly going "yeah but..." I am hearing what your saying and I do know that it's all good and true, I'm just not feeling it.

Maybe you don't always need to feel it. maybe that's what "fake it 'til you make it" is for... :)
 

Andy

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My old psychologist use to do that to, it made things so much easier. My psychiatrist doesn't take the time. For how long I have been seeing him, I know there are a lot of patient histories besides mine for him to try to know, he knows very little about me. I always see him pull my file out of a stack, the only reason he actually opens the file is to make sure I am correct when I tell him my medications.

I did mention my father, your right. I have also (I think?) mentioned that my father added "suicide" for me into his will. He loves me, I know he loves me but he doesn't have faith in me. He also tells me everytime he puts something in his will that he leaves hi new car to me because your brothers can buy there own, I know that's out of love but it also says to me (my opinion) no hope.

Fake it til you make it does work. I guess I just need to get out of this funk. Maybe then I will be able to get back to faking it.:tapfingers:
 

Kobayashi

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Interesting Thread.

I'm in a no-man's land, and nobody has really diagnosed me with anything, except for GAD with secondary depression. I have OCD thoughts, but only really when my anxiety swings high. For the past few months I've been doing a lot of research and trying to find out exactly what might be the cause of my mental/mood disorder. Some signs point to Bipolar II, but its quite elusive.

I am on a regimen of Cipralex 25mg and risperidone .25mg. The cipralex initially aided my GAD greatly. As the months have passed by I find myself and my mood following a very predictable pattern: I feel generally "fine" for 2 weeks or so, followed by 2 weeks of increasingly intense anxiety and depression. Then, this cycle seems to repeat itself. The down side of the cycle is getting more and more difficult to deal with. I'm fully functional, work etc, but its a really tough go and life just isn't what it could be when in this state. I've done some bipolar screening on my own and don't do things like impulsive shopping of feelings of elation and or mania. But i sometimes wonder if the periods of anxiety and irritability could fall into the category of hypomania? I just wish things could level out. I didn't experience these cyclic swings (or at least they weren't apparent to me before I went on medication). If there were a med that would help me to stabilize - i'd take it.
 
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