Anxiety as a marker of severity in acute mania

González-Pinto, Ana; Galan, J.L.; Martı́n-Carrasco, Manuel; Ballesteros, Javier; Mauriño, Jorge; Vieta, Eduard

doi:10.1111/j.1600-0447.2012.01882.x

Cited by 14 publications

(6 citation statements)

References 27 publications

(34 reference statements)

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“…Anxiety has also been related to more severe illness in another study, having important consequences regarding symptom-rated and patient-rated outcomes 73–75. An association of the presence of anxiety symptoms with greater severity of manic symptoms and longer hospitalisations was demonstrated 76. Patients can experience work, family, social impairment and increased healthcare costs and strains on family support 73.…”

Section: Discussionmentioning

confidence: 98%

Prevalence, impact and treatment of generalised anxiety disorder in bipolar disorder: a systematic review and meta-analysis

Preti

Vrubļevska

Veroniki

et al. 2016

Evid Based Mental Health

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Question Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression; however, less attention has been paid to comorbidity of anxiety disorders with BD. Generalised anxiety disorder (GAD) is one of the most prevalent anxiety disorders that is highly comorbid with other mental disorders. We carried out a systematic review and meta-analysis to assess the degree of comorbidity between GAD and BD. Study selection and analysis We searched for all studies, which included primary data concerning the existence of GAD in patients with BD. The literature search strategy, selection of publications and the reporting of results have been conducted with PRISMA guidelines. The meta-analysis calculated prevalence estimates using the variance-stabilising Freeman-Tukey double arcsine transformation. We applied the inverse variance method using both fixed-effects and random-effects models to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran's Q and I 2 statistics, respectively. Findings The current meta-analysis analysed data from 28 independent studies and a total of 2975 patients from point prevalence studies and 4919 patients from lifetime studies. The overall random-effects point prevalence of GAD in patients with BD was 12.2% (95% CI 10.9% to 13.5%) and the overall random-effects lifetime estimate was 15.1% (95% CI 9.7% to 21.5%). Both estimates reported significant heterogeneity (94.0% and 94.7%, respectively). Conclusions Published studies report prevalence rates with high heterogeneity and consistently higher than those typically reported in the general population. It is believed that comorbid GAD might be associated with a more severe BD course and increased suicidality, and it is unknown how best to treat such conditions. The current meta-analysis confirms that GAD is highly prevalent in BD and the rate is higher in comparison to those in the general population.

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Section: Discussionmentioning

confidence: 98%

Prevalence, impact and treatment of generalised anxiety disorder in bipolar disorder: a systematic review and meta-analysis

Preti

Vrubļevska

Veroniki

et al. 2016

Evid Based Mental Health

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“…Previous empirical findings examining the association between anxiety comorbidity and mania/hypomania have been equivocal. González-Pinto and colleagues (2012) demonstrated that among bipolar I inpatients, anxiety symptoms were associated with exacerbated manic symptoms. Conversely, Saunders and colleagues (2012) found no significant relationship between anxiety and severity/number of manic episodes; Magalhães and colleagues (2010) reported no association between the presence of OCD and manic symptoms.…”

Section: Discussionmentioning

confidence: 99%

The role of lifetime anxiety history in the course of bipolar spectrum disorders

Titone

Freed

O’Garro-Moore

et al. 2018

Psychiatry Research

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Individuals with bipolar spectrum disorder (BSD) frequently meet criteria for comorbid anxiety disorders, and anxiety may be an important factor in the etiology and course of BSDs. The current study examined the association of lifetime anxiety disorders with prospective manic/hypomanic versus major depressive episodes. Participants were 244 young adults (aged 17-26) with milder forms of BSDs (i.e., bipolar-II, cyclothymia, BD-NOS). First, bivariate analyses assessed differences in baseline clinical characteristics between participants with and without DSM-IV anxiety diagnoses. Second, negative binomial regression analyses tested whether lifetime anxiety predicted number of manic/hypomanic or major depressive episodes developed during the study. Third, survival analyses evaluated whether lifetime anxiety predicted time to onset of manic/hypomanic and major depressive episodes. Results indicated that anxiety history was associated with greater illness severity at baseline. Over follow-up, anxiety history predicted fewer manic/hypomanic episodes, but did not predict number of major depressive episodes. Anxiety history also was associated with longer time to onset of manic/hypomanic episodes, but shorter time to onset of depressive episodes. Findings corroborate past studies implicating anxiety disorders as salient influences on the course of BSDs. Moreover, results extend prior research by indicating that anxiety disorders may be linked with reduced manic/hypomanic phases of illness.

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“…Symptoms of anxiety frequently co‐occur during a manic episode, and are a predictor of poor outcome; including greater severity of manic symptoms,197 a longer time to remission,197, 198 and more reported side effects of medication 198. There have been no studies specifically examining the efficacy of any agents in reducing symptoms of anxiety during a manic episode, although these symptoms do tend to improve concurrently with mood disturbance.…”

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Anxiety as a marker of severity in acute mania

Cited by 14 publications

References 27 publications

Prevalence, impact and treatment of generalised anxiety disorder in bipolar disorder: a systematic review and meta-analysis

Prevalence, impact and treatment of generalised anxiety disorder in bipolar disorder: a systematic review and meta-analysis

The role of lifetime anxiety history in the course of bipolar spectrum disorders

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

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