[Anxiety disorders comorbidity in bipolar disorder]

Comorbidity of bipolar and anxiety disorders: An overview of trends in research

Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder (BD), but it also adversely impacts the course, outcome, and treatment of BD. The present review provides an overview of the current trends in research on comorbid anxiety and BDs based on prior reviews and meta-analyses (n = 103), epidemiological surveys, and large-scale clinical studies. The results reiterated the fact that at least half of those with BD are likely to develop an anxiety disorder in their lifetimes and a third of them will manifest an anxiety disorder at any point of time. All types of anxiety disorders were equally common in BD. However, there was a wide variation in rates across different sources, with most of this discrepancy being accounted for by methodological differences between reports. Comorbid anxiety disorders negatively impacted the presentation and course of BD. This unfavourable clinical profile led to poorer outcome and functioning and impeded treatment of BD. Despite the extensive body of research there was paucity of data on aetiology and treatment of anxiety disorder comorbidity in BD. Nevertheless, the substantial burden and unique characteristics of this comorbidity has important clinical and research implications.

Effects of deep breathing in patients with bipolar disorder

PURPOSE

Our aim was to evaluate the effects of deep breathing exercises in subjects with bipolar disorder.

DESIGN AND METHODS

This was an open-label, uncontrolled clinical trial with three assessments: preintervention, postintervention, and follow-up.

FINDINGS

The Hamilton Anxiety Rating Scale, BECK-A, Hamilton Depression Rating Scale, and Young Mania Rating Scale had significant preintervention, postintervention, and follow-up differences. The results indicated that the deep breathing protocol was effective in reducing anxiety levels in patients with bipolar disorder. The deep breathing protocol has no negative side effects and might be applied to decrease anxiety symptoms in individuals with bipolar disorder.

PRACTICE IMPLICATIONS

The results provide direction for providing quality care that reduces anxiety levels in patients with bipolar disorder.

Comorbidity of anxiety and depression in children and adolescents: 20 years after

Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.

The identification of unipolar mania subtype based on anxiety comorbidity

BACKGROUND

Unipolar mania is a controversial topic. Clinical research has focused on establishing specific characteristics that allow it to be distinguished from bipolar disorder (BD).

METHODS

Experienced and carefully trained clinicians evaluated a clinical sample of 298 patients with bipolar disorder using structured instruments to analyze the clinical and socio-demographics differences between people with manic episodes over the course of a 15-year illness compared with participants with histories of manic and depressive episodes.

RESULTS

According to adopted criteria, 16 (5.6%) participants presented unipolar mania (UM) and 282 participants presented manic and depressive (MD) phases. UM patients reported significantly more hospitalizations and medications, as well as more frequent psychosis at the first episode in the UM group than compared to the MD group. The UM group showed worse overall functioning, although differences in mood status between groups were not identified. Comorbid anxiety disorders and anxiety symptoms occurred significantly less frequently in the UM group.

LIMITATIONS

Because of the cross-sectional design, determining causal relationships was not possible. Furthermore, the retrospective nature of the UM diagnosis could not exclude a future depressive episode.

CONCLUSIONS

The presence of anxiety disorders can differentiate patients with unipolar mania from those with bipolar mania.

Epidemiology and management of anxiety in patients with bipolar disorder

Epidemiological and clinical studies have reported a high prevalence of anxiety symptoms in bipolar disorder, either in manic or depressive episodes, although these symptoms do not always meet criteria for a specific anxiety disorder. In addition to anxiety symptoms, bipolar disorder frequently presents with co-morbid axis I conditions, with anxiety disorders being the most common co-morbidity. Therefore, the objective of this article is to review clinical and epidemiological studies that have investigated the association between bipolar disorder and anxiety. Available data on the efficacy of treatments for bipolar disorder and co-morbid anxiety disorders are also reviewed. Existing guidelines do recognize that co-morbid anxiety has a negative impact on the course and outcome of bipolar disorder; however, there have been very few double-blind, controlled trials examining the treatment response of patients with bipolar disorder and co-occurring anxiety disorders. There is some positive evidence for quetiapine, olanzapine in combination with fluoxetine or lithium, and lamotrigine with lithium, and negative evidence for risperidone. Other therapies used for bipolar disorder, including several mood stabilizers, antidepressants, atypical antipsychotics and benzodiazepines, have been shown to reduce anxiety symptoms, but specific data for their effects in patients with anxiety symptoms co-morbid with bipolar disorder are not available. The co-occurrence of anxiety and bipolar disorder has implications for diagnosis, clinical outcome, treatment and prognosis. Careful screening for co-morbid anxiety symptoms and disorders is warranted when diagnosing and treating patients with bipolar disorder.

Anxiety comorbidity and quality of life in bipolar disorder patients

OBJECTIVE

To assess the impact of anxiety comorbidity on the quality of life of patients with bipolar disorder (BD).

METHODS

We undertook a cross-Sectional survey of 162 BD outpatients interviewed with the Structured Clinical Interview for DSM-IV. The primary outcome measure was quality of life, assessed with the 26-item WHO Quality of Life Instrument (WHOQOL-BREF).

RESULTS

Anxiety comorbidity in BD patients was associated with lower scores in all domains of quality of life. The impact of anxiety comorbidity on the psychological domain of the WHOQOL-BREF was kept, even when the current level of depression was added to the model as a confounding factor. Current anxiety comorbidity was also associated with lifetime alcohol abuse and dependence, rapid cycling, lifetime psychosis, number of suicide attempts, and a lower score in the Global Assessment of Functioning measure.

CONCLUSION

Our findings suggest that anxiety comorbidity in BD patients is related to lower quality of life, particularly on the psychological domain. BD-anxiety comorbidity may be associated with such markers of illness severity as number of suicide attempts, rapid cycling, lifetime alcohol abuse, and psychosis. The recognition and treatment of anxiety comorbidity may help patients with BD to relieve their psychological pain and improve their overall quality of life.