Are Anxiety Disorders Associated with a More Severe Form of Bipolar Disorder in Adolescents?

By Ratheesh, Aswin; Srinath, Shoba et al. | Indian Journal of Psychiatry, October-December 2011 | Go to article overview
Save to active project

Are Anxiety Disorders Associated with a More Severe Form of Bipolar Disorder in Adolescents?


Ratheesh, Aswin, Srinath, Shoba, Reddy, Y. Janardhan, Girimaji, Satish, Seshadri, Shekhar, Thennarasu, K., Hutin, Yvan, Indian Journal of Psychiatry


Byline: Aswin. Ratheesh, Shoba. Srinath, Y. Janardhan Reddy, Satish. Girimaji, Shekhar. Seshadri, K. Thennarasu, Yvan. Hutin

Background: Anxiety disorders are common among children and adolescents with bipolar disorder. Among adults, anxiety disorder comorbidity is associated with a more severe form of bipolar disorder and a poorer outcome. There is limited data on the effect of comorbid anxiety disorder on bipolar disorder among children and adolescents. Aim: To study the prevalence of anxiety disorders among adolescents with remitted bipolar disorder and examine their association with the course and severity of illness, global functioning, and quality of life. Materials and Methods: We evaluated 46 adolescents with DSM IV bipolar disorder (I and II) who were in remission, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. We measured quality of life using the Pediatric Quality of Life Inventory and global functioning using the Children's Global Assessment Scale, and then compared these parameters between adolescents with and without current anxiety disorders. We also compared the two groups on other indicators of severity such as number of episodes, suicidal ideation, presence of psychotic symptoms, and response to treatment. Results: Among the 46 subjects, the prevalence of current and lifetime anxiety disorders were 28% (n=13) and 41% (n=19), respectively. Compared with others, adolescents with anxiety had more lifetime suicidal ideation, more number of episodes, lower physical, psychosocial, and total subjective quality of life, and lower global functioning. Conclusions: Among adolescents with bipolar disorder, anxiety disorders are associated with a poorer course, lower quality of life, and global functioning. In these subjects, anxiety disorders should be promptly recognized and treated.

Introduction

Anxiety disorders are common among adults with bipolar disorder and influence their clinical and functional outcome. [sup][1],[2] In adults, they are associated with greater severity, earlier age-at-onset, mixed state presentations, poor symptomatic and functional recovery, suicidal behavior, diminished acute response to pharmacological treatment, decreased quality of life, and unfavorable course and outcome. [sup][3],[4]

Although the consequences of anxiety disorders comorbidity among adults are well elucidated, the data are inconclusive among children and adolescents. [sup][5],[6],[7],[8],[9] Drug-induced hypomania was more common among children with anxiety disorders (30-36%), than those without comorbid anxiety disorders (22%). [sup][8] In one study, those adolescents with anxiety had a lower age at onset and more hospitalizations than those without. [sup][5] A later study has suggested that adolescents with post-traumatic stress disorder (PTSD) and comorbid bipolar disorder are more likely to have a substance use disorder compared with those who did not have PTSD. [sup][9] Studies that have compared the illness severity among children and adolescents with or without anxiety disorders using the Clinical Global Impression severity scale have been inconsistent in their findings. [sup][6],[8] In two studies, presence of anxiety disorders had no influence on global functioning. [sup][5],[6] The studies that have determined the association of anxiety with outcomes among children and adolescents with bipolar disorder have two main limitations. First, they do not provide enough information regarding illness severity and quality of life of these children and adolescents. Second, they assessed study subjects during affective episodes. Anxiety symptoms may occur exclusively during mood episodes [sup][10],[11],[12],[13] and hence, the assessment of anxiety during mood episodes may result in overestimation of the prevalence of anxiety disorders. Only one study estimated the prevalence of anxiety disorders in remission. [sup][14] However, remission from mood episodes was determined historically without a clear assessment of the same.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

Are Anxiety Disorders Associated with a More Severe Form of Bipolar Disorder in Adolescents?
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?