Are anxiety disorders associated with a more severe form of bipolar disorder in adolescents?

Abstract

Background:Anxiety disorders are common among children and adolescents with bipolar disorder. Among adults, anxiety disorder comorbidity is associated with a more severe form of bipolar disorder and a poorer outcome. There is limited data on the effect of comorbid anxiety disorder on bipolar disorder among children and adolescents.Aim:To study the prevalence of anxiety disorders among adolescents with remitted bipolar disorder and examine their association with the course and severity of illness, global functioning, and quality of life.Materials and Methods:We evaluated 46 adolescents with DSM IV bipolar disorder (I and II) who were in remission, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. We measured quality of life using the Pediatric Quality of Life Inventory and global functioning using the Children's Global Assessment Scale, and then compared these parameters between adolescents with and without current anxiety disorders. We also compared the two groups on other indicators of severity such as number of episodes, suicidal ideation, presence of psychotic symptoms, and response to treatment.Results:Among the 46 subjects, the prevalence of current and lifetime anxiety disorders were 28% (n=13) and 41% (n=19), respectively. Compared with others, adolescents with anxiety had more lifetime suicidal ideation, more number of episodes, lower physical, psychosocial, and total subjective quality of life, and lower global functioning.Conclusions:Among adolescents with bipolar disorder, anxiety disorders are associated with a poorer course, lower quality of life, and global functioning. In these subjects, anxiety disorders should be promptly recognized and treated.

Psychiatric comorbidity in patients with pediatric bipolar disorder – A systematic review

“…Sixteen of the included studies reported the prevalence of ADHD in patients with PBD 14,15,27–40 . The studies showed that comorbid ADHD occurred in 0%–87.1% (weighted mean prevalence = 59.5%) of patients with PBD.…”

“…The studies showed that comorbid ADHD occurred in 0%–87.1% (weighted mean prevalence = 59.5%) of patients with PBD. Current comorbid ADHD occurred in 15%–70% (weighted mean prevalence = 51.4%) of patients in remission 15,33 …”

“…Comorbid separation anxiety occurred in 0%–49.5% (weighted mean prevalence = 29.4%) of patients with PBD. Current comorbid separation anxiety occurred in 0% of patients in remission 15 …”

“…Eight of the included studies reported the prevalence of social phobia in patients with PBD 15,27,28,35,36,38,40,41 . Comorbid social phobia occurred in 3.2%–39.1% (weighted mean prevalence = 24%) of patients with PBD.…”

“…Comorbidity often has therapeutic implications with regards to treatment choices and response and conversely some pharmacological treatments of comorbid conditions, such as atomoxetine used to treat ADHD, may increase the risk of destabilization of mood 12,13 . Further comorbidity may influence functioning 11,14,15 . Therefore, it is of paramount importance to improve our understanding of comorbid conditions in PBD.…”