An evaluation of the impact of co-occurring anxiety and substance use disorder on bipolar disorder illness outcomes in STEP-BD

Abstract

Background: Anxiety disorder (AD) and substance use disorder (SUD) highly co-occur with bipolar disorder (BD). AD and/or SUD co-occurrence is associated with poorer clinical outcomes in BD. However, respective associations between AD and/or SUD diagnoses and BD outcomes require clarification. Baseline data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were therefore utilized to investigate independent and simultaneous contributions of ADs and SUDs on clinical variables in BD. Methods: Two latent factors, "pathological anxiety" and "substance use problems," were derived from presence/absence of lifetime AD and SUD diagnoses. Latent dimensions' associations with clinical variables, obtained from the Affective Disorders Evaluation, Mini-International Neuropsychiatric Interview and Range of Impaired Functioning, were estimated via structural equation modeling (SEM). Results: Modeled independently, pathological anxiety and substance use problems were significantly associated with several variables. Yet when modeled simultaneously, pathological anxiety's associations with functional impairment, past-year rapid cycling, and past-year %time spent anxious and depressed remained while most variables' associations with substance use problems became non-significant. The only significant latent-factor interaction evidenced was for age of BD onset.

Transdiagnostic group cognitive behaviour therapy for anxiety in bipolar disorder—a pilot feasibility and acceptability study

“…The most common comorbid anxiety conditions are panic disorder, social anxiety and generalised anxiety disorders; however, multimorbidity is also common [ 6 ]. Co-morbid anxiety in bipolar disorder is associated with greater current symptom severity, increased impairment and increased risk of mood episodes [ 8 ] and lifetime suicide attempts [ 9 ]. Studies have also found that anxiety in bipolar disorder is also associated with lower quality of life, earlier relapse and diminished role function, with a greater impact also being found with the presence of multiple co-occurring anxiety disorders.…”

Results from a randomized, double‐blind, placebo‐controlled, crossover, multimodal‐MRI pilot study of gabapentin for co‐occurring bipolar and cannabis use disorders

“…Cigarette‐smoking status and anxiety disorder diagnosis, though specified a priori as moderators of interest in our proposal, were also evaluated due to significant between‐randomization‐order differences on these variables. Their impact on gabapentin‐induced changes in brain GABA and/or glutamate levels was predicted because both have been associated with disturbances in GABAergic and/or glutamatergic transmission that are purported to be central to their phenomenology, 70,71 as well as worse clinical outcomes in individuals with BD + CUD relative to those who do not smoke cigarettes 72 and do not have anxiety disorders 73 . Going forward, urn randomization 74 by smoking status and anxiety disorder in a larger sample, in conjunction with a parallel‐group (between‐subject) study design to rule out potentially genuine order effects, will be critical to overcoming the interpretational challenges presented by the findings of this preliminary study.…”

Examining the Joint Factor Structure of Mania, Internalizing, and Thought Disorder Symptoms in a Large Online Sample

“…The symptom criteria for many categorical disorders are heterogeneous, but this is true for the mania criteria especially. In addition to manic symptoms overlapping with thought disorder and internalizing symptoms, other manic symptoms such as risk taking and distractibility could conceivably be classified as externalizing in nature (Johnson et al, 2012;Prisciandaro et al, 2019). In contrast, symptoms from many other disorders are best classified within one or two existing spectra (e.g., generalized anxiety symptoms within internalizing; Kotov et al, 2022).…”