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Abstract

Background: Studies indicate bipolar disorder (BD) syndromal symptoms are commonly preceded by sub-syndromal BD symptoms, dysregulated sleep, irritability, and anxiety. We aimed to evaluate prevalence and clinical correlates of anxiety disorders (ADs) at BD onset in outpatients with versus without at least one AD at BD onset. Methods: 246 bipolar spectrum outpatients, according to the text revision of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM- IV-TR), attending Sacco University Hospital in Milan, were recruited and their onset and clinical features assessed retrospectively. Patients were stratified into those with versus without an AD at BD onset (w/A and wo/A), according to a semistructured clinical interview to provide diagnoses according to (DSM- IV-TR).
Results: 29% of patients reported being w/A, among whom Panic Disorder (PD, in 55.6%) was the most frequent AD, and first AD occurred approximately 4 years before BD diagnosis. Patients w/A versus wo/A had higher (p < 0.05) rates of BDII and first mood episode being depression versus elevation (mania/hypomania), and lifetime rates of separation anxiety disorder, substance poly-abuse and benzodiazepine abuse. In contrast, patients wo/A had higher lifetime rates of alcohol and illicit drug use. Conclusion: In this naturalistic sample, ADs, in particular PD, preceded BD in almost 1/3 of BD outpatients, and had distinctive clinical correlates. Further investigation into relationships between BD and AD at onset may enhance early BD diagnosis and treatment.

Introduction

Bipolar disorder (BD) is a highly disabling condition affecting about 1.5% of the general population globally (Kendall et al., 2014) and responsible for 1.3% of total years lived with disability and 0.4% of total disability-adjusted life years worldwide (Ferrari et al., 2016). BD is characterized by different and complex clinical features over its longitudinal course, including recurrent mood episodes, comorbid psychiatric and medical problems, progressive social and cognitive impairment and, ultimately, much higher suicide/suicide attempt risks, compared to the general population (Cremaschi et al., 2017; Simon et al., 2007) Indeed, BD is frequently associated with other psychiatric comorbid conditions, in particular anxiety disorders (ADs) (Nabavi et al., 2015) and substance use disorders (Gold et al., 2018). Epidemiologic and clinical studies report lifetime rates of development of at least one AD over the longitudinal course of BD ranging between 39% and 55% (Vázquez et al., 2014).