Academic journal article The Israel Journal of Psychiatry and Related Sciences

The Comorbidity of Anxiety Disorders in Bipolar I Patients: Prevalence and Clinical Correlates

Academic journal article The Israel Journal of Psychiatry and Related Sciences

The Comorbidity of Anxiety Disorders in Bipolar I Patients: Prevalence and Clinical Correlates

Article excerpt

Abstract: The purpose of this study was to determine the prevalence of lifetime anxiety disorders in bipolar I patients in Sanliurfa, Turkey, and to assess the association between comorbidity and several demographic and clinical variables. Seventy bipolar I patients in remission were assessed by means of the Structured Clinical Interview for DSM-IV axis I Disorders-Clinician Version (SCID-I-CV), Anxiety Disorder Module in order to detect lifetime comorbid anxiety disorders. Nineteen (27.1%) bipolar I patients were diagnosed with at least one lifetime comorbid anxiety disorder. The most common anxiety disorders in this sample were obsessive compulsive disorder (12.8%) and specific phobia (12.8%), followed by panic disorder (5.7%). Anxiety disorder comorbidity appears to be associated with greater number of hospitalizations, psychotic symptoms and suicide attempts in patients with bipolar I disorder. As comorbidity has a clear impact on the course of bipolar patients, special attention to this issue should be paid when interviewing bipolar patients.

Introduction

Clinical and epidemiological studies have provided convincing evidence that comorbid anxiety disorders are relatively prevalent among patients with bipolar disorder, found in up to 65% of cases (1-5). Comorbidity of anxiety disorders may be associated with greater suicidality, substance abuse, resistance to pharmacological treatment, and poor outcome (2, 6-8). Bipolar disorder patients with high level of anxiety symptoms may have an earlier onset of mood illness (1, 8). Comorbidity of anxiety disorders has been claimed to be the strongest predictor of poor compliance in bipolar patients (9).

Multiple anxiety disorder comorbidities occur in a significant minority of bipolar disorder patients. Tamam and Ozpoyraz (5) found lifetime multiple anxiety disorders in 39% of bipolar disorder outpatients in remission. Henry et al. (10) studied 318 inpatients including bipolar I, and found that 24% had at least one lifetime anxiety disorder and 11% of the patients had more than one such disorder.

The link between bipolar disorder and panic disorder has been demonstrated by genetic studies (11, 12). MacKinnon et al. (13) studied 203 families of probands with bipolar disorder and demonstrated that family history of bipolar disorder is a risk factor of panic disorder. Family studies also revealed an association between bipolar disorder and obsessive-compulsive disorder. Coryell et al. (14) diagnosed obsessive-compulsive disorder-OCD in 2.7% and 5.3% of relatives of bipolar I and bipolar II patients, respectively, compared to 0.8% among relatives of non-bipolar probands.

The purpose of this study was to determine the prevalence of lifetime anxiety disorders in bipolar I patients and to assess the association between comorbidity and several demographic and clinical variables. This study provides a view of lifetime anxiety disorder comobidity in bipolar I patients in Sanliurfa, Turkey.

Methods

Participants

All patients presenting at the Bipolar Disorder Out-patients Clinics of the Harran University, Sanliurfa, Southeastern Turkey, between 2002 and 2004 were considered for inclusion in the study. Patients diagnosed with bipolar disorder in the psychiatry clinics of Harran University Research Hospital (a tertiary level health institute which receives referrals from the southeastern part of Turkey) were recruited for the study. Among patients enrolled in this unit, those who met the following criteria were included in the study: 1) aged at least 18 years; 2) DSM-IV diagnosis of bipolar I disorder; 3) clinically in remission for at least one month before inclusion in the study as corroborated by routinely administered scales during follow-up visits (17-item Hamilton Rating Scale for Depression score of < 7 and Young Mania Rating Scale score of < 5 for at least one month in two consecutive visits were used as confirmative scores for remission); and 4) written informed consent obtained before participation in the study. …

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