Comorbid Anxiety in Children and Adolescents With Bipolar Spectrum Disorders

Abstract

Objective Anxiety disorders are among the most common comorbid conditions in youth with bipolar disorder (BP). We aimed to examine the prevalence and correlates of comorbid anxiety disorders among youth with BP. Methods As part of the Course and Outcome of Bipolar Youth study (COBY), 446 youth ages 7 to 17, who met DSM-IV criteria for BP-I (n=260), BP-II (n=32) or operationalized criteria for BP not otherwise specified (BP-NOS; n=154) were included. Subjects were evaluated for current and lifetime Axis-I psychiatric disorders at intake using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children–Present and Lifetime version (K-SADS-PL), and standardized instruments to assess functioning and family history. Results Forty-four percent (n=194) of the sample met DSM-IV criteria for at least one lifetime anxiety disorder, most commonly Separation Anxiety (24%) and Generalized Anxiety Disorders (16%). Nearly 20% met criteria for two or more anxiety disorders. Overall, anxiety disorders predated the onset of BP. BP-II subjects were more likely than BP-I or BP-NOS subjects to have a comorbid anxiety disorder. After adjusting for confounding factors, BP youth with anxiety were more likely to have BP-II, longer duration of mood symptoms, more severe ratings of depression, and family history of depression, hopelessness and somatic complaints during their worst lifetime depressive episode than those without anxiety. Conclusions Comorbid anxiety disorders are common in youth with BP, and most often predate BP onset. BP-II, a family history of depression, and more severe lifetime depressive episodes distinguish BP youth with comorbid anxiety disorders from those without. Careful consideration should be given to the assessment of comorbid anxiety in BP youth.

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

“…In the COBY study, 44% of youth had at least one lifetime anxiety disorder, and nearly 20% had two or more, with the most prevalent being separation anxiety (24%) and generalized anxiety disorder (GAD) (16%) (234). A family history study that included 157 patients (age 6-17 years) with BD I revealed extremely high rates of comorbid attention-deficit hyperactivity disorder (ADHD) (85%), oppositional defiant disorder (90%), two or more anxiety disorders (64%), conduct disorder (51%), and SUD (12%) (235).…”

Pediyatrik Bipolar Bozuklukta Fenomenolojik Özellikler ve Psikiyatrik Komorbidite

“…Despite BD may frequently manifest in broad phenotype among young subjects, majority of the subjects in this study had DSM-IV-defined BD type I or II. However it may be important to note that many studies on pediatric BD that were cited in this paper have also included subjects with a diagnosis of BD-NOS (15,19,30). This study may have several limitations.…”

“…Furthermore, nearly half of the adult or young subjects with a diagnosis of BD have reported depressive episodes before their diagnosis of BD (3,4,(13)(14)(15). Meanwhile, young subjects with BD have been reported to have high rates of psychiatric comorbidity (3,4,(16)(17)(18)(19)(20)(21)(22). Despite comorbidity rates and patterns may change depending on the age group (children vs adolescents) and setting (clinical vs community samples), high rates of attention deficit hyperactivity disorder (ADHD) (up to 80%), oppositional defiant disorder (ODD) (up to 80%), conduct disorder (CD) (up to 37%), anxiety disorders (AD) (up to 56%), substance use disorders (SUD) (up to 40%), and obsessive compulsive disorder (OCD) (up to 40%) have been reported (16)(17)(18)(19)(20)(21)(22).…”

“…Because studies have consistently shown high rates of psychiatric comorbidity in pediatric BD (3,4,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)35), it is suggested that all young subjects diagnosed with BD should be thoroughly assessed for comorbid psychiatric disorders (3,4,10,24,35). However rates and patterns of comorbid psychiatric diagnoses may change across studies mainly depending on the sample characteristics, referral center, and study methodology (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)35).…”

Separation Anxiety in Children and Adolescents

“…Separation anxiety disorder has an association with higher rates of subsequent depression in a limited number of studies (Horn & Wuyek, 2010). Separation anxiety disorders are among the most common comorbid conditions in youth with bipolar disorder (BP) (Sala et al, 2010). A history of separation anxiety disorder is frequently reported by patients with obsessive-compulsive disorder (Mroczkowski et al, 2011).…”