Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Prevalence and distinct correlates of anxiety, substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder. Do comorbid anxiety disorders moderate the effects of psychotherapy for bipolar disorder? Results from STEP-BD. The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey. Are patients with bipolar affective disorder socially disadvantaged? A comparison with a control group. Anxiety disorder comobidity in Bipolar I Disorder: relationship to depression severity and treatment outcome. Prospective 12-month course of bipolar disorder in out-patients with and without comorbid anxiety disorders. Medical burden in bipolar disorder: findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE). Cognitive impairment in the euthymic phase of affective disorder. Subsyndromal symptoms assessed in longitudinal, prospective follow-up of a cohort of patients with bipolar disorder. Mortality of patients with mood disorders: follow-up over 34-38 years. Traumatic life events in bipolar disorder: impact on BDNF levels and psychopathology. Clinical, psychological and environmental predictors of prospective suicide events in patients with Bipolar Disorder. The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. Symptomatic and functional outcome of bipolar disorder in Butajira, Ethiopia. The epidemiology of bipolar disorder: sociodemographic, disability and service utilization data from the Australian National Study of Low Prevalence (Psychotic) Disorders. Risk for bipolar illness in patients initially hospitalized for unipolar depression.
OBJECTIVE The authors provide a detailed perspective on the correlates of comorbid anxiety in a large , well-characterized sample of bipolar disorder patients . METHOD Anxiety and its correlates were examined in a cross-sectional sample from the first 500 patients with bipolar I or bipolar II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder , a multicenter project funded by the National Institute of Mental Health design ed to evaluate the longitudinal outcome of patients with bipolar disorder . RESULTS Lifetime comorbid anxiety disorders were common , occurring in over one-half of the sample , and were associated with younger age at onset , decreased likelihood of recovery , poorer role functioning and quality of life , less time euthymic , and greater likelihood of suicide attempts . Although substance abuse disorders were particularly prevalent among patients with anxiety disorders , comorbid anxiety appeared to exert an independent , deleterious effect on functioning , including history of suicide attempts ( odds ratio=2.45 , 95 % CI=1.4 - 4.2 ) . CONCLUSIONS An independent association of comorbid anxiety with greater severity and impairment in bipolar disorder patients was demonstrated , highlighting the need for greater clinical attention to anxiety in this population , particularly for enhanced clinical monitoring of suicidality . In addition , it is important to determine whether effective treatment of anxiety symptoms can lessen bipolar disorder severity , improve response to treatment of manic or depressive symptoms , or reduce suicidality BACKGROUND Recent data indicate high prevalence of both anxiety and substance comorbidity in bipolar disorder . However , few studies have utilized public sector sample s , and only one has attempted to separate contributions of each type of comorbidity . METHODS 328 inpatient veterans with bipolar disorder across 11 sites were assessed using selected Structured Clinical Interview for DSM-IV modules and self-reports . RESULTS Comorbidity was common ( current : 57.3 % ; lifetime : 78.4 % ) , with multiple current comorbidities in 29.8 % . Substance comorbidity rate was comparable to rates typically reported in non-veteran inpatient sample s ( 33.8 % current , 72.3 % lifetime ) . Selected anxiety comorbidity rates exceeded those in other inpatient sample s and appeared more chronic than episodic/recurrent ( 38.3 % current , 43.3 % lifetime ) . 49 % of PTSD was due to non-combat stressors . Major correlates of current substance comorbidity alone were younger age , worse marital status , and higher current employability . Correlates of current anxiety comorbidity alone were early age of onset , greater number of prior-year depressive episodes , higher rates of disability pension receipt , and lower self-reported mental and physical function . Combined comorbidity resembled anxiety comorbidity . LIMITATIONS This is a cross-sectional analysis of acutely hospitalized veterans . CONCLUSIONS Distinct patterns of substance and anxiety comorbidity are striking , and may be subserved by distinct neurobiologic mechanisms . The prevalence , chronicity and functional impact of anxiety disorders indicate the need for improved recognition and treatment of this other dual diagnosis group is warranted . Clinical and research interventions should recognize these divergent comorbidity patterns and provide individualized treatment built " from the patient out . OBJECTIVE At least 50 % of individuals with bipolar disorder have a lifetime anxiety disorder . Individuals with both bipolar disorder and a co-occurring anxiety disorder experience longer illness duration , greater illness severity , and poorer treatment response . The study explored whether comorbid lifetime anxiety in bipolar patients moderates psychotherapy treatment outcome . METHOD In the Systematic Treatment Enhancement Program r and omized controlled trial of psychotherapy for bipolar depression , participants received up to 30 sessions of intensive psychotherapy ( family-focused therapy , interpersonal and social rhythm therapy , or cognitive-behavioral therapy ) or collaborative care , a three-session comparison treatment , plus pharmacotherapy . Using the number needed to treat , we computed effect sizes to analyze the relationship between lifetime anxiety disorders and rates of recovery across treatment groups after 1 year . RESULTS A total of 269 patients ( 113 women ) with a comorbid lifetime anxiety disorder ( N=177 ) or without a comorbid lifetime anxiety disorder ( N=92 ) were included in the analysis . Participants with a lifetime anxiety disorder were more likely to recover with psychotherapy than with collaborative care ( 66 % compared with 49 % recovered over 1 year ; number needed to treat=5.88 , small to medium effect ) . For patients without a lifetime anxiety disorder , there was no difference between rates of recovery in psychotherapy compared with collaborative care ( 64 % compared with 62 % recovered ; number needed to treat=50 , small effect ) . Participants with one lifetime anxiety disorder were likely to benefit from intensive psychotherapy compared with collaborative care ( 84 % compared with 53 % recovered ; number needed to treat=3.22 , medium to large effect ) , whereas patients with multiple anxiety disorders exhibited no difference in response to the two treatments ( 54 % compared with 46 % recovered ; number needed to treat=12.5 , small effect ) . CONCLUSIONS Depressed patients with bipolar disorder and comorbid anxiety may be in particular need of additional psychotherapy for treating acute depression . These results need to be replicated in studies that stratify bipolar patients to treatments based on their anxiety comorbidity status In order to estimate the prevalence of affective disorders in Hungary a sample of the Hungarian adult population ( 18 - 64 years ) selected at r and om was interviewed using the Diagnostic Interview Schedule ( DIS ) which generated DSM-III-R diagnoses . The lifetime rate for Major Depressive Disorder ( MDD ) was 15.1 % , and for Bipolar Disorders ( BD ) 5.1 % . The female-to-male ratio was 2.7 for MDD and nearly equal for BD . The 1-year and 1-month period prevalence rates were 7.1 % and 2.6 % for MDD and 0.9 % and 0.5 % for manic episodes . A higher rate of divorced or separated persons was found among individuals with a lifetime diagnosis of MDD . Besides these , the lifetime diagnosis of BD coexisted with higher rates of the never-married state . The highest hazard rate for the development of BD or MDD was in the range 15 - 19 years but in MDD another peak was also found in the range 45 - 50 years . The first peak was characteristic of the recurrent , and the other one of the single form of MDD . Insomnia , loss of energy , decreased interest , concentration problems were the most common symptoms during the depressive episode , independent of polarity . Higher rates of lifetime diagnosis of dysthymia and all kinds of anxiety disorder were revealed among persons with MDD . BD was associated with GAD ( Generalized Anxiety Disorder ) , and panic disorder more often than chance BACKGROUND Bipolar affective disorder ( BPAD ) has considerable implication s for personal and social functioning . However a tendency to be over-represented in high socio-economic classes has been reported in earlier studies , suggesting that social disadvantage accompanying the illness is not severe . In addition , an association between affective disorders in general and increased residential mobility has been suggested , but it is unclear if such an association exists with BPAD . OBJECTIVES ( 1 ) To investigate the suggestion made in previous studies that patients with bipolar disorder are advantaged socially . ( 2 ) To test the hypothesis that patients with bipolar disorder show greater residential mobility compared with other patients with psychiatric disorders . METHODS Ninety patients with DSM IV diagnosis of bipolar disorder admitted to the acute in-patient unit of a public-financed district psychiatric service in Dublin were compared with a control group of 91 r and omly selected patients with other psychiatric diagnoses , excluding schizophrenia .  Socio-economic , educational and employment ratings were compared , and also  duration of illness , frequency of admission and residential mobility .  The data were collected retrospectively from case notes and through semistructured interviews with patients or their relatives . The bipolar group was compared with the control group and to the unipolar depression subgroup . RESULTS The bipolar and control groups were found to have similar demographic and socio-economic features , although the bipolar group had more years of education compared with the whole control group but not when compared with the unipolar depression group . The bipolar group showed longer duration of psychiatric disorder , more frequent hospital admissions and more frequent residential moves since the onset of the illness . CONCLUSION Bipolar patients requiring in-patient care in this service experience severe disruption to their lives over prolonged periods The present study investigated the greater symptom severity and poorer treatment response found in patients with bipolar illness and anxiety comorbidity , and examined depression as a potential mediator of this relationship . The sample consisted of 92 patients in an acute episode of Bipolar I Disorder with a current or past history of an anxiety disorder . Diagnoses were based on structured clinical interview , and participants were assessed at pre-treatment and then r and omly assigned to pharmacotherapy alone or pharmacotherapy plus family intervention . Patients were assessed on a monthly basis by blind assessors over 28 months . Compared to patients without anxiety comorbidity , individuals with bipolar disorder and an anxiety disorder possessed greater current symptom severity , even after controlling for depression severity . Logistic regression analysis identified that being female and having higher current depression but not manic severity predicted comorbid anxiety . Comorbid anxiety was associated with poorer treatment response in the sample regardless of treatment type , particularly in subsequent depressive symptoms . Multiple regression analyses indicated that current depression but not manic severity partially mediated the relationship between comorbid anxiety and treatment outcome . Results from the current study investigating comorbid anxiety disorders are consistent with past research limited to anxiety symptoms . Depression only partially accounted for the link between comorbid anxiety and greater symptom severity and poorer treatment response , and examination of other factors is warranted . Because of the clinical relevance of comorbid anxiety in severe affective disorders , treatments design ed to specifically address both concerns are needed BACKGROUND The impact of anxiety disorders has not been well delineated in prospect i ve studies of bipolar disorder . AIMS To examine the association between anxiety and course of bipolar disorder , as defined by mood episodes , quality of life and role functioning . METHOD A thous and thous and out- patients with bipolar disorder were followed prospect ively for 1 year . RESULTS A current comorbid anxiety disorder ( present in 31.9 % of participants ) was associated with fewer days well , a lower likelihood of timely recovery from depression , risk of earlier relapse , lower quality of life and diminished role function over I year of prospect i ve study . The negative impact was greater with multiple anxiety disorders . CONCLUSIONS Anxiety disorders , including those present during relative euthymia , predicted a poorer bipolar course . The detrimental effects of anxiety were not simply a feature of mood state . Treatment studies targeting anxiety disorders will help to clarify the nature of the impact of anxiety on bipolar course OBJECTIVES Individuals with bipolar disorder have high rates of other medical comorbidity , which is associated with higher mortality rates and worse course of illness . The present study examined common predictors of medical comorbidity . METHODS The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study ( Bipolar CHOICE ) enrolled 482 participants with bipolar I or bipolar II disorder in a six-month , r and omized comparative effectiveness trial . Baseline assessment s included current and lifetime DSM-IV-TR diagnoses , demographic information , psychiatric and medical history , severity of psychiatric symptoms , level of functioning , and a fasting blood draw . Medical comorbidities were categorized into two groups : cardiometabolic ( e.g. , diabetes , hyperlipidemia , and metabolic syndrome ) and non-cardiovascular ( e.g. , seizures , asthma , and cancer ) . Additionally , we looked at comorbid substance use ( e.g. , smoking and drug dependence ) . RESULTS We found that 96.3 % of participants had at least one other medical comorbidity . Older age predicted a greater likelihood of having a cardiometabolic condition . Early age of onset of bipolar symptoms was associated with a lower chance of having a cardiometabolic condition , but a greater chance of having other types of medical comorbidity . Additional predictors of other medical comorbidities in bipolar disorder included more time spent depressed , less time spent manic/hypomanic , and longer duration of illness . Medications associated with weight gain were associated with low high-density lipoprotein and abnormal triglycerides . CONCLUSIONS There appears to be a substantial medical burden associated with bipolar disorder , highlighting the need for collaborative care among psychiatric and general medical providers to address both psychiatric and other medical needs concomitantly in this group of patients BACKGROUND A review of studies of cognition in the euthymic phase of unipolar and bipolar affective disorder reveals diverging results . METHODS The study was design ed as a controlled cohort study , with the Danish psychiatric case register of admissions used to identify patients and the Danish civil register to identify controls . Patients who were hospitalized between 19 and 25 years ago with an affective diagnosis and who at interviews fulfilled criteria for a primary affective unipolar or bipolar disorder , according to ICD-10 , were compared with age- and gender-matched controls . Interviews and assessment of the cognitive function  were made in the euthymic phase of the disorder . In all , 118 unipolar patients , 28 bipolar patients and 58 controls were included . Analyses were adjusted for differences in the level of education and for sub clinical depressive and anxiety symptoms . RESULTS Patients with recurrent episodes were significantly more impaired than patients with a single episode and more impaired than controls . Also , within patients the number of prior episodes seemed to be associated with cognitive outcome . There was no difference in the severity of the dysfunction between unipolar and bipolar patients . CONCLUSIONS Cognitive impairment in out- patients with unipolar and bipolar disorder appears to be associated with the number of affective episodes BACKGROUND Many patients with bipolar disorder ( BD ) do not regain full function following an acute illness episode , but the extent to which this impairment is the result of persistent symptoms has not been well established . This study examined factors associated with persistent subsyndromal symptoms in a well characterized group of BD patients who were prospect ively followed for an average of 3 years . METHODS Detailed life charting data from 138 patients with BD were review ed . Patients were categorized into euthymic , subsyndromal or syndromal groups according to the clinical state during their most recent year of follow-up . The three groups were then examined with respect to comorbidity , function and treatment received . RESULTS Patients with subsyndromal symptoms had high rates of comorbid anxiety disorders , and were more likely to have increased rates of eating disorders as well . Patients with subsyndromal symptoms had lower global assessment of function ( GAF ) scores than euthymic patients , and had as many clinic contacts and medication trials as patients with full episodes of illness . CONCLUSIONS Persistent subsyndromal symptoms in BD patients are associated with high rates of comorbidity that is important to recognize and treat in order to optimize mood and functioning BACKGROUND All follow-up studies of causes of death in affective disordered patients have found they have markedly elevated suicide rates and a less reproducible increased mortality from other causes . The reported rates by gender , disorder type and treatment are more variable . METHODS Hospitalised affective disordered patients ( n=406 ) were followed prospect ively for 22 years or more . Later , mortality was assessed for 99 % of them at which time 76 % had died . RESULTS St and ardised Mortality Rates ( observed deaths/expected deaths ) for patients were elevated especially for suicide and circulatory disorders in both men and women . Women actually had higher suicide rates but that did not take into account the twofold increase in general population rates for men . Unipolar patients had significantly higher rates of suicide than bipolar Is or IIs . In all groups long term medication treatment with antidepressants alone or with a neuroleptic , or with lithium in combination with antidepressants and /or neuroleptics significantly lowered suicide rates even though the treated were more severely ill . Although at the age of onset the suicide rates were most elevated , from ages 30 to 70 the rates were remarkably constant despite the different courses of illness . LIMITATIONS The patients were identified as in patients and followed prospect ively . The treatments were uncontrolled and are not quantifiable but were documented during the follow-up . CONCLUSIONS Men and women hospitalised for affective disorders have elevated mortality rates from suicide and circulatory disorders . Unipolars have higher suicide rates than bipolar Is or IIs . Long term medication treatment lowers the suicide rates , despite the fact that it was the more severely ill who were treated BACKGROUND There is evidence that vulnerability to depression and anxiety disorders is markedly increased by traumatic life events . While childhood abuse has been reported to be associated with poorer outcomes in bipolar disorder , little is known about the neurobiological basis underlying this association . The aim of this study was to ascertain whether bipolar patients who were exposed to a traumatic event or events ( TE )  have lower brain-derived neurotrophic factor ( BDNF ) levels and more severe psychopathology as indicated by increased comorbidity and other clinical features when compared to those who were not exposed to TE . METHODS One-hundred and sixty-three consecutively recruited bipolar out patients were assessed by Structured Clinical Interview for DSM-IV ( SCID ) and st and ard protocol in order to evaluation psychopathology and clinical features . The reported TE was assessed using DSM-IV stem criteria for trauma ( as defined by A1 and A2 criteria for trauma for post-traumatic stress disorder ) . Subjects were divided into 2 groups according to presence or absence of lifetime TE . The levels of BDNF , comorbidity and other clinical features were compared between groups . RESULTS After adjusting for confounders , results indicated that bipolar patients with a history of TE have alcohol abuse/dependence ( p < 0.001 ) , anxiety comorbidity , and lower levels of serum BDNF ( p < 0.01 ) compared to those without a history of TE . There was no difference between the 2 groups in age of onset , presence of psychosis , other substance abuse and dependence , rapid cycling or suicide attempts . CONCLUSIONS Our findings suggest that TE are associated with significantly increased prevalence of alcohol and anxiety comorbidity as well as lower BDNF levels in bipolar patients . It is possible that a decrease in BDNF levels may account for increased comorbidity , but further prospect i ve studies are required to confirm this Patients with Bipolar Disorder ( BD ) have high rates of suicide compared to the general population . The present study investigates the predictive power of baseline clinical , psychological and environmental characteristics as risk factors of prospect i ve suicide events ( attempts and completions ) . Data was collected from the Systematic Treatment Enhancement Program for Bipolar Disorder ( STEP-BD ) study . 3083 bipolar patients were included in this report , among these 140 ( 4.6 % ) had a suicide event  ( 8 died by suicide and 132 attempted suicide ) .  Evaluation and assessment forms  were used to collect clinical , psychological and socio-demographic information . Chi-square and independent t-tests were used to evaluate baseline characteristics . Potential prospect i ve predictors were selected on the basis of prior literature and using a screening analysis of all risk factors that were associated with a history of suicide attempt at baseline and were tested using a Cox regression analysis . The strongest predictor of a suicide event was a history of suicide attempt ( hazard ratio = 2.60 , p-value < 0.001 ) in line with prior literature . Additional predictors were : younger age , a high total score on the personality disorder question naire and a high percentage of days spent depressed in the year prior to study entry . In conclusion , the present findings may help clinicians to identify patients at high risk for suicidal behavior upon presentation for treatment BACKGROUND Since recent NIMH Bipolar Disorder Workshops highlighted the dearth of longitudinal and controlled studies of bipolar illness , the Stanley Foundation Bipolar Network ( SFBN ) has recruited a large cohort of patients with bipolar disorder to begin to address these issues . This report describes the demographics and course of illness characteristics of this study population . METHODS The first 261 out patients to be diagnosed by the Structured Clinical Interview for DSM-IV ( SCID ) and complete a detailed patient and a brief clinician question naire are described . All patients met DSM-IV criteria for bipolar I ( n=211 ) , bipolar II ( n=42 ) , or NOS ( n=5 ) or schizoaffective ( n=3 ) , bipolar type . Chi-square and t-tests were used to examine statistically significant associations among important demographic and descriptive items . RESULTS The general demographic and illness characteristics were similar to those in many bipolar clinical sample s and not dissimilar from those reported in epidemiological surveys . The majority of patients had been hospitalized , with almost half reporting a worsening of illness over time , and two-thirds were not asymptomatic between episodes . First treatment for patients had been delayed by an average of 10 years from illness onset ( by SCID ) . Almost a third of patients had attempted suicide at least once , and 30 % reported current suicidal ideation at study entry . A total of 62 % reported moderate to severe impact of the illness on occupational functioning . Early onset bipolar illness ( < or = 17 years old ) was associated with increased frequency of mood switches , worsening course of illness , and history of early abuse ( physical , verbal , or sexual ) . CONCLUSION The SFBN represents a sample of predominantly BP I patients largely recruited from the community who will be followed in detail longitudinally , participate in clinical trials , and thus help advance our underst and ing and treatment of this life-threatening medical disorder . While there is a broad range of illness characteristics and severity , the majority of patients have been severely impacted by their illness despite the availability of multiple conventional treatment approaches in the community . These data further underscore the need for development of new and earlier treatment interventions . LIMITATION The SFBN population is limited by the lack of r and om selection and represents a cohort willing to be treated and followed intensively in academic tertiary referral centers . While its characteristics are similar to many clinical study population s , the generalizability to non-clinic population s remains uncertain BACKGROUND Limited information is available on the outcome of bipolar disorder in developing countries . OBJECTIVE To describe the symptomatic and functional outcome of bipolar disorder . METHODS The psychoses and affective disorder modules of the CIDI were used to screen 68,378 individuals by a door-to-door survey of a defined district in Ethiopia . In addition , key informants were used to identify individuals with probable major mental illnesses . SCAN interviews were completed at the second stage to confirm the diagnosis . A total of 315 cases of bipolar disorder were identified , of which 264 ( 69 recent-onset and 195 prevalent cases ) were prospect ively followed for a mean of 2.5 ( range 1 - 4 ) years by baseline and annual clinical assessment s using symptom rating scales . Functional dimensions of the SF-36 scale were used to describe functional outcome . R and om coefficient analyses were used to evaluate potential correlates of outcome . RESULTS The magnitudes of mania and depression symptoms were elevated at baseline but improved with follow-up , although the improvement was less marked for depression . Sociodemographic or clinical variables were not associated with the improvements in symptomatic outcome . Between 35 % and 47 % of the recent-onset cases had functional role restrictions , while 42 - 52 % of long-st and ing cases had such restrictions during the follow-up years . Similarly , social and physical functioning deficits were also present in 52 - 86 % and 35 - 47 % of recent-onset and long-st and ing cases , respectively . The magnitude of depression and mania symptoms was associated with poor functional outcome , while male sex , rural residence and being married were associated with better functional outcome . CONCLUSION Although there were improvements in function with follow-up , between one-third and one-half of cases continued to have functional deficits OBJECTIVES Data from the Australian National Study of Low Prevalence ( Psychotic ) Disorders were used to describe the clinical and sociodemographic profile of individuals with bipolar disorder , their levels of impairment and disability , and use of medication and treatment services .  METHODS A 1-month census of contacts with mental health services , private psychiatric and general practice s , as well as contact points in marginalized setting s , was conducted in a national catchment of 1.1 million adults . The census yielded 3,800 individuals who screened positive for psychosis , of whom a r and om sample of 980 were administered a comprehensive semi-structured interview schedule . Results are presented on 112 persons with an ICD-10 diagnosis of bipolar disorder . RESULTS Overall , 69.6 % of the 112 persons who met the ICD-10 criteria for bipolar disorder reported a recurrent episodic illness , 25.0 % had a chronic course without clear remissions , and 5.4 % had a single episode of mania . Assessed on a lifetime basis , suicidal ideation was common ( 78.6 % ) and levels of drug and alcohol abuse/dependence were high ( 32.1 % ) . The majority ( 84.8 % ) had had at least one contact with inpatient , outpatient or emergency services in the previous year . Those with serious impairment had levels of service utilization similar to the rest of the sample , but were more likely to report a poorer quality of life and unmet service needs . While the percentage experiencing social and occupational dysfunction was substantial and similar for both sexes , women appeared to be better integrated socially than men . Comparisons with schizophrenia patients within the same survey sample highlighted less chronic impairment but equal or greater utilization of services by bipolar patients . CONCLUSIONS Despite low levels of chronicity , the burden of social disablement associated with bipolar disorder is high . The data suggest a number of important gaps in the provision of services for this predominantly treated population OBJECTIVE To assess the risk for subsequent development of mania or hypomania , the authors conducted a 15-year prospect i ve follow-up study of a large , young cohort of patients originally hospitalized for unipolar major depression . METHOD Patients who were hospitalized for unipolar major depression ( N=74 ; mean age=23.0 years , SD=3.8 ) were assessed prospect ively as in patients and then followed up five times over 15 years , at approximately 2 , 5 , 8 , 11 , and 15 years after discharge . Manic or hypomanic episodes , medications , and rehospitalizations were determined by st and ardized assessment s at each follow-up . Polarity conversions were evaluated by survival analyses . RESULTS By the 15-year follow-up , 27 % of the study group had developed one or more distinct periods of hypomania , while another 19 % had at least one episode of full bipolar I mania . Depressed patients with psychosis at the index depressive episode were significantly more likely than nonpsychotic patients to demonstrate subsequent mania or hypomania at follow-up . Those with family histories of bipolar illness showed a nonsignificantly higher rate of switching to mania or hypomania . Spontaneous and antidepressant-associated manias did not differ in frequency . Fewer than one-half of the patients who showed an eventual bipolar course had received prescriptions for mood stabilizers in any follow-up year . CONCLUSIONS Young depressed in patients with psychotic features may be at especially high risk for eventually developing mania . The probability for developing a bipolar spectrum disorder increases in linear fashion for patients at risk for polarity conversion during the first 10 - 15 years after an index depressive episode
Our results suggest a high rate of lifetime concurrent anxiety disorders in bipolar disorder .
The diagnostic issues at the interface are particularly difficult because of the substantial symptom overlap .
BACKGROUND Bipolar affective disorder has a high rate of comorbidity with a multitude of psychiatric disorders and medical conditions .
Among all the potential comorbidities , co-existing anxiety disorders st and out due to their high prevalence .
AIMS To determine the lifetime prevalence of comorbid anxiety disorders in bipolar affective disorder under the care of psychiatric services through systematic review and meta- analysis .