Anxiety Disorders in 318 Bipolar Patients: Prevalence and Impact on Illness Severity and Response to Mood Stabilizer.[CME]
J Clin Psychiatry 2003;64(3):331-335
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Objective: The aim of this study was to assess
the frequency and impact of anxiety disorders on illness severity
and response to mood stabilizers in bipolar disorders.
Method: 318 bipolar patients consecutively
admitted to the psychiatric wards of 2 centers as inpatients were
recruited. Patients were interviewed with a French version of the
Diagnostic Interview for Genetic Studies providing DSM-IV Axis I
diagnoses and demographic and historical illness characteristics.
Logistic and linear regressions to adjust for age and sex were
Results: In a population with mostly bipolar
type I patients (75%), 24% had at least 1 lifetime anxiety
disorder (47% of these patients had more than 1 such disorder),
16% of patients had panic disorder (with and without agoraphobia,
and panic attacks), 11% had phobia (agoraphobia without panic
disorder, social phobia, and other specific phobias), and 3% had
obsessive-compulsive disorder. Comorbidity with anxiety disorders
was not correlated with severity of bipolar illness as assessed
by the number of hospitalizations, psychotic characteristics,
misuse of alcohol and drugs, and suicide attempts (violent and
nonviolent). Bipolar patients with an early onset of illness had
more comorbidity with panic disorder (p < .05). Anxiety
disorders were detected more frequently in bipolar II patients
than in other patients, but this difference was not significant
(p = .09). Bipolar patients with anxiety responded less well to
anticonvulsant drugs than did bipolar subjects without anxiety
disorder (p < .05), whereas the efficacy of lithium was
similar in the 2 groups. There was also a strong correlation
between comorbid anxiety disorders and depressive temperament in
bipolar patients (p = .004).
Conclusion: Patients with bipolar disorders
often have comorbid anxiety disorders, particularly patients with
depressive temperament, and the level of comorbidity seems to
decrease the response to anticonvulsant drugs.