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J Affect Disord. 2014 Sep;166:243-8. doi: 10.1016/j.jad.2014.05.017. Epub 2014 May 23.

Impact of comorbid anxiety disorders and obsessive-compulsive disorder on 24-month clinical outcomes of bipolar I disorder.

Author information

1
Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea.
2
IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong 3220, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia.
3
Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, School of Psychology and Psychiatry, Commercial Road, Melbourne 3004, VIC, Australia.
4
Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia; Orygen Youth Health Research Centre, Parkville 3052, VIC, Australia.
5
IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong 3220, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia; Orygen Youth Health Research Centre, Parkville 3052, VIC, Australia; Florey Institute for Neuroscience and Mental Health, Parkville 3052, VIC, Australia. Electronic address: MIKEBE@BarwonHealth.org.au.

Abstract

BACKGROUND:

This study investigated the impact of comorbid obsessive-compulsive disorder (OCD) and four anxiety disorders [panic disorder (PD), agoraphobia, social anxiety disorder (SAD), and generalized anxiety disorder (GAD)] on the clinical outcomes of bipolar disorder.

METHODS:

This study analysed data of 174 patients with bipolar I disorder who participated in the prospective observational study. Participants were assessed every 3 months for 24 months. The primary outcome measure was the achievement of symptomatic remission, defined by a total score on the Young Mania Rating Scale (YMRS) of ≤12 and a total score on the 21-item Hamilton Depression Rating Scale (HAMD-21) of ≤8.

RESULTS:

Comorbidity was associated with decreased likelihood of remission. However, the impact of individual disorders on outcome differed according to clinical and treatment situations. Most comorbid anxiety disorders and OCD had a negative effect on remission during the first year of evaluation, as measured by the HAMD-21, and in patients taking a conventional mood stabilizer alone. However, the association with poorer outcome was observed only for a few specific comorbid disorders in the second year (GAD and OCD), as measured by YMRS-defined remission (OCD), and in patients with olanzapine therapy (GAD and OCD).

LIMITATIONS:

Follow-up evaluation of comorbid disorders was lacking.

CONCLUSIONS:

Comorbid anxiety disorders and OCD negatively influenced the clinical course of bipolar disorder. Specifically, OCD had a consistently negative impact on the outcome of bipolar I disorder regardless of clinical situation. Effective strategies for the control of these comorbidities are required to achieve better treatment outcomes.

KEYWORDS:

Anxiety disorder; Bipolar disorder; Comorbidity; Observational study; Obsessive–compulsive disorder; Remission

PMID:
25012437
DOI:
10.1016/j.jad.2014.05.017
[Indexed for MEDLINE]
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