Social phobia, panic disorder and suicidality in subjects with pure and depressive mania

Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician

“…A meta-analysis 50 showed that the risk for suicide attempts is increased in the presence of comorbidity with anxiety disorders. Dilsaver et al 68 also found that 57.9% of patients with depressive mania and intra-episodic panic disorder had been suicidal during the study with scores in the Schedule for Affective disorders and Schizophrenia (SADS) 69 suicide subscale higher than 3 (i.e. mild suicidality) having all patients suicide ideation according to SADS.…”

Prevalence and correlates of bipolar I disorder among adults with primary youth‐onset anxiety disorders

“…In particular, with respect to BD, anxiety disorders are associated with earlier age of onset, poorer treatment response (Feske et al, 2000), exacerbated illness course and severity (Goodwin and Hoven, 2002;Boylan et al, 2004;Keller, 2006;Otto et al, 2006), and suicidality (Dilsaver and Chen, 2003). Previous studies have also demonstrated that anxiety disorders among youth are significant predictors of later BD in adulthood (Goodwin and Hamilton, 2002;Johnson et al, 2000;Kessler et al, 1997;Kim-Cohen et al, 2003;Perugi et al, 2001), and anxiety disorders predate BD among most youth with comorbid anxiety disorders and BD (Dickstein et al, 2005;Dilsaver and White, 1986;Masi et al, 2001;Wagner, 2006).…”

Comorbidity

“…In the ECA study, almost half of BD patients also had social anxiety disorder , and in half of them, social phobia appeared more than a decade earlier than BD (Kessler et al 1999 ). The phase of the disorder plays an important role; social phobia is virtually absent in purely manic patients and present in two-thirds of mixed or depressive (Dilsaver and Chen 2003 ). Peculiarly, one group of authors didn't fi nd any such symptoms in depressed BD patients (Pini et al 1997 ).…”

“…It has been reported that up to 21 % of anxiety patients also suffer from BD (Yerevanian et al 2001 ;Savino et al 1993 ;Schneier et al 1992 ;Wittchen et al 1994 ;Lensi et al 1996 ;Perugi et al 1997Perugi et al , 1999Bowen et al 1994 ;Goldstein and Levitt 2007 ) and in these patients anxiety has a very early age at onset, often preceding the onset of BD itself (Goldstein and Levitt 2007 ). The phase of the disorder plays an important role; rates of anxiety are very low in purely and euphoric manic patients, while multiple anxiety disorders are present in the majority of mixed or depressive (Gaudiano and Miller 2005 ;Dilsaver and Chen 2003 ;McElroy et al 1995 ;Himmelhoch and Garfi nkel 1986 ) and seem to correlate with rapid cycling (Boylan et al 2004 ;MacKinnon et al 2002MacKinnon et al , 2003a. The literature suggest a strong connection between anxiety and impulsivity in BD patients, probably because increased arousal and reduced cognitive effi ciency associated with anxiety could result in less rational and more impulsive thinking (Taylor et al 2008 ;Bellani et al 2012 ).…”

“…The phase of the disorder plays an important role; panic is virtually absent in purely manic patients and present in more than 80 % of mixed or depressive patients (Dilsaver and Chen 2003 ). Comorbid panic disorder is related to worse outcome of BD with younger age at onset (Schurhoff et al 2000 ), more depressive episodes and possibly higher suicidality Kilbane et al 2009 ;Neves et al 2009 ).…”