Comorbidity of Anxiety Disorders and Substance Abuse with Bipolar Mood Disorders and Relationship with Clinical Course

By Ghoreishizadeh, Mohammad Ali; Amiri, Shahrokh et al. | Iranian Journal of Psychiatry, Summer 2009 | Go to article overview

Comorbidity of Anxiety Disorders and Substance Abuse with Bipolar Mood Disorders and Relationship with Clinical Course


Ghoreishizadeh, Mohammad Ali, Amiri, Shahrokh, Bakhshi, Salam, Golmirzaei, Javad, Shafiee-Kandjani, Ali Reza, Iranian Journal of Psychiatry


Objective: Patients with bipolar mood disorder constitute a relatively large number of individuals hospitalized in psychiatric hospitals. This disorder is highly co-morbid with other psychiatric disorders and may effect their clinical course. The goal of this study was to determine the co-occurrence rate of anxiety disorders and substance abuse with bipolar mood disorders and their impact on clinical course.

Methods: 153 bipolar patients (type I) were selected among the hospitalized patients at Razi Psychiatric Hospital in Tabriz, Iran, from September 2007 to October 2008 through convenience sampling method. The participants were evaluated by a structured clinical interview based on DSM-IV criteria (SCID), Hamilton Rating Scale for Depression (HRSD) and Young Mania Rating Scale (YMRS).

Results: Co-morbidity of anxiety disorders was 43%. Occurrence of anxiety disorders was 26% for obsessive-compulsive disorder, 24.8% for generalized anxiety disorder, 3.9% for phobia and 2% for panic disorder. Co-morbidity of substance abuse was 7.2% and the highest occurrence of substance abuse was 5.2% for alcoholism and 3.9% for opium. No significant difference was observed between the severity of disease and duration of hospitalization in bipolar patients with or without anxiety disorder. The severity of disease and duration of hospitalization in bipolar patients with substance abuse was higher compared to bipolar patients without substance abuse (P<0.05).

Conclusions: This study suggests that there is a high co-morbidity between anxiety disorders and substance abuse with bipolar disorder. Further, this study suggests that co-occurrence of substance abuse disorder with bipolar disorder increases the severity of the disease and duration of hospitalization.

Key Words: Anxiety Disorders, Substance Abuse, Bipolar Disorder, Co-morbidity, Severity of Disease

Iran J Psychiatry 2009; 4:120-125

Bipolar disorders are among the most common psychiatric disorders which usually become recrudescent and chronic (1). As bipolar disorders may lead to major consequences, psychiatrists attempt to use effective therapies while facing different therapeutic problems. Bipolar mood disorder is influenced by different problems such as psychological stresses (2), co-occurrent diseases (3, 4) and substance abuse (5). Co-occurrence of anxiety disorders and substance abuse are of diagnostic and therapeutic importance because they may complicate the clinical symptoms, decrease treatment response (6, 7),and provide for the establishment of another psychological disorder (8). According to several studies, co- existence of an anxiety disorder with bipolar disorder intensifies the severity of the diseases (9- 11). It is also determined that co-occurrence of substance abuse with bipolar disorder increases the duration of hospitalization (12). However, Henri C et al (13) obtained converse results which indicate that cooccurrence of anxiety disorders are not related to the severity of bipolar disease and duration of hospitalization. Overall, concurrent substance abuse disorder and anxiety disorders increase the chronicity, disability, and mortality of bipolar disorders.

Co-morbidity of anxiety and substance abuse disorders has many adverse effects on patients with bipolar disorders. The co-occurrence of anxiety disorders with bipolar disorder was 10.6-62.5% for panic disorder, 7.8-42.5% for social phobia, 3.2-35% for obsessivecompulsive disorder, 7-37.8% for post-traumatic stress disorder and 32.7% for generalized anxiety disorder (14). In addition, co-occurrence of anxiety disorders with bipolar disorder was reported 55.8% , and generalized anxiety disorder and panic disorder had the highest rate of co-occurrence with bipolar disorder. Another study also reported higher rate of this occurrence (15, 10).

Life-looking study about co-occurrence of substance abuse with bipolar disorder also shows that 57% of patients with type I bipolar disorder were abusing or dependent to one substance, 28. …

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Comorbidity of Anxiety Disorders and Substance Abuse with Bipolar Mood Disorders and Relationship with Clinical Course
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