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Preti A, Vrublevska J, Veroniki AA, Huedo-Medina TB, Fountoulakis KN. Prevalence, impact and treatment of generalised anxiety disorder in bipolar disorder: a systematic review and meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2016; 19:73-81. [PMID: 27405742 PMCID: PMC10699460 DOI: 10.1136/eb-2016-102412] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 01/04/2023]
Abstract
QUESTION Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression; however, less attention has been paid to comorbidity of anxiety disorders with BD. Generalised anxiety disorder (GAD) is one of the most prevalent anxiety disorders that is highly comorbid with other mental disorders. We carried out a systematic review and meta-analysis to assess the degree of comorbidity between GAD and BD. STUDY SELECTION AND ANALYSIS We searched for all studies, which included primary data concerning the existence of GAD in patients with BD. The literature search strategy, selection of publications and the reporting of results have been conducted with PRISMA guidelines. The meta-analysis calculated prevalence estimates using the variance-stabilising Freeman-Tukey double arcsine transformation. We applied the inverse variance method using both fixed-effects and random-effects models to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran's Q and I(2) statistics, respectively. FINDINGS The current meta-analysis analysed data from 28 independent studies and a total of 2975 patients from point prevalence studies and 4919 patients from lifetime studies. The overall random-effects point prevalence of GAD in patients with BD was 12.2% (95% CI 10.9% to 13.5%) and the overall random-effects lifetime estimate was 15.1% (95% CI 9.7% to 21.5%). Both estimates reported significant heterogeneity (94.0% and 94.7%, respectively). CONCLUSIONS Published studies report prevalence rates with high heterogeneity and consistently higher than those typically reported in the general population. It is believed that comorbid GAD might be associated with a more severe BD course and increased suicidality, and it is unknown how best to treat such conditions. The current meta-analysis confirms that GAD is highly prevalent in BD and the rate is higher in comparison to those in the general population.
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Affiliation(s)
- Antonio Preti
- Genneruxi Medical Center, Cagliari, Italy
- Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy
| | - Jelena Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | | | - Tania B Huedo-Medina
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bobo WV, Reilly-Harrington NA, Ketter TA, Brody BD, Kinrys G, Kemp DE, Shelton RC, McElroy SL, Sylvia LG, Kocsis JH, McInnis MG, Friedman ES, Singh V, Tohen M, Bowden CL, Deckersbach T, Calabrese JR, Thase ME, Nierenberg AA, Rabideau DJ, Schoenfeld DA, Faraone SV, Kamali M. Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar I or II disorder: results from the Bipolar CHOICE trial. J Affect Disord 2014; 161:30-5. [PMID: 24751304 PMCID: PMC4113323 DOI: 10.1016/j.jad.2014.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/28/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the longer-term effects of adjunctive benzodiazepines on symptom response during treatment in patients with bipolar disorders. METHODS The study sample consisted of 482 patients with bipolar I or II disorder enrolled in a 6-month, randomized, multi-site comparison of lithium- and quetiapine-based treatment. Changes in clinical measures (BISS total and subscales, CGI-BP, and CGI-Efficacy Index) were compared between participants who did and did not receive benzodiazepine treatment at baseline or during follow-up. Selected outcomes were also compared between patients who did and did not initiate benzodiazepines during follow-up using stabilized inverse probability weighted analyses. RESULTS Significant improvement in all outcome measures occurred within each benzodiazepine exposure group. Benzodiazepine users (at baseline or during follow-up) experienced significantly less improvement in BISS total, BISS irritability, and CGI-BP scores than did benzodiazepine non-users. There were no significant differences in these measures between patients who did and did not initiate benzodiazepines during follow-up in the weighted analyses. There was no significant effect of benzodiazepine use on any outcome measure in patients with comorbid anxiety or substance use disorders. LIMITATIONS This is a secondary analysis of data from a randomized effectiveness trial that was not designed to address differential treatment response according to benzodiazepine use. CONCLUSIONS Adjunctive benzodiazepines may not significantly affect clinical outcome in lithium- or quetiapine-treated patients with bipolar I or II disorder over 6 months, after controlling for potential confounding factors.
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Affiliation(s)
- William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA,Correspondence to: William V. Bobo, MD, MPH, 200 First Street SW, Generose 2A, Rochester, MN 55904, , Telephone: 507-255-9412
| | | | | | - Benjamin D. Brody
- Weill Cornell Medical College of Cornell University, New York, NY, USA
| | | | - David E. Kemp
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Richard C. Shelton
- University of Alabama-Birmingham School of Medicine, Birmingham, AL, USA
| | - Susan L. McElroy
- Lindner Center for HOPE, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - James H. Kocsis
- Weill Cornell Medical College of Cornell University, New York, NY, USA
| | | | | | - Vivek Singh
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mauricio Tohen
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Charles L. Bowden
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | - Michael E. Thase
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Stephen V. Faraone
- Upstate Medical University, State University of New York, Syracuse, NY, USA
| | - Masoud Kamali
- University of Michigan School of Medicine, Ann Arbor, MI, USA
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Bauer M, Glenn T, Grof P, Rasgon NL, Marsh W, Sagduyu K, Alda M, Lewitzka U, Schmid R, Whybrow PC. Relationship between adjunctive medications for anxiety and time spent ill in patients with bipolar disorder. Int J Psychiatry Clin Pract 2009; 13:70-7. [PMID: 24946124 DOI: 10.1080/13651500802450514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective. Many patients with bipolar disorder take adjunctive medications for anxiety. Using naturalistic data, we investigated the relationship between the use of adjunctive anxiolytics and the time spent in episodes or with subsyndromal mood symptoms. Methods. This was a post-hoc analysis of 310 patients with bipolar disorder who previously recorded mood and medications daily for 5 months using ChronoRecord software. One hundred patients were taking adjunctive anxiolytics for at least 50% of days; 210 were not. Of the 100 patients, 73 were taking a benzodiazepine. All patients taking anxiolytics were also receiving treatments for bipolar disorder. Results. Patients with bipolar disorder who were taking adjunctive medications for anxiety spent more time ill. Comparing patients who were taking or not taking anxiolytics, the mean days spent either in any episode or with subsyndromal symptoms was 45.6 vs. 29.6%, respectively (P<0.001), the mean days in any episode was 17.1 vs. 9.2%, respectively (P=0.016), and the mean days with subsyndromal depression was 26.4 vs. 16.2%, respectively (P=0.004). Conclusion. While this methodology cannot determine causality, these findings highlight the need for controlled studies of the long-term impact of adjunctive medications for anxiety on mood symptoms in patients being treated for bipolar disorder.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
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