Medical burden in bipolar disorder: findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE). Prevalence and distinct correlates of anxiety, substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder. Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Do comorbid anxiety disorders moderate the effects of psychotherapy for bipolar disorder? Results from STEP-BD. Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS) Alcohol, drugs, and psychiatric comorbidity among homeless women: an epidemiologic study. Prevalence and Characteristics of Multiple Psychiatric Disorders in Cardiac Rehabilitation Patients Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder. Major depression and posttraumatic stress disorder symptoms following severe burn injury in relation to lifetime psychiatric morbidity. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition. Anxiety disorder comobidity in Bipolar I Disorder: relationship to depression severity and treatment outcome. Lifetime prevalence of substance or alcohol abuse and dependence among subjects with bipolar I and II disorders in a voluntary registry. Traumatic life events in bipolar disorder: impact on BDNF levels and psychopathology. Bipolar disorder, schizoaffective disorder, and schizophrenia overlap: a new comorbidity index. Use of opioid medications for chronic noncancer pain syndromes in primary care Randomized, placebo-controlled trial of risperidone for acute treatment of bipolar anxiety. Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. Mindfulness-based Cognitive Therapy (MBCT) in bipolar disorder: Preliminary evaluation of immediate effects on between-episode functioning Psychiatric comorbidities in a community sample of women with fibromyalgia Medical illness and response to treatment in primary care panic disorder. Medical comorbidity in women and men with schizophrenia Prospective 12-month course of bipolar disorder in out-patients with and without comorbid anxiety disorders.
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 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 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 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 Abstract This article reports the initial results of a prospect i ve study on the prevalence of  psychiatric disorders in the Dutch population aged 18–64 . The objectives and the design of the study are described elsewhere in this issue . A total of 7076 people were interviewed in person in 1996 . The presence of the following disorders was determined by means of the CIDI : mood disorders , anxiety disorders , eating disorders , schizophrenia and other non-affective psychoses , and substance use disorders . Psychiatric disorders were found to be quite common . Some 41.2 % of the adult population under 65 had experienced at least one DSM-III-R disorder in their lifetime , among them 23.3 % within the preceding year . No gender differences were found in overall morbidity . Depression , anxiety , and alcohol abuse and dependence were most prevalent , and there was a high degree of comorbidity between them . The prevalence rate encountered for schizophrenia was lower ( 0.4 % lifetime ) than generally presumed . A comparison with findings from other countries is made . Relevant determinants of psychiatric morbidity were analysed BACKGROUND Very little is known about the mental health of homeless women . The present study is one of the first to focus on psychiatric diagnosis and comorbidity in a population of homeless women systematic ally interviewed with a structured instrument . METHOD Three hundred homeless women r and omly selected from St. Louis shelters were interviewed using the Diagnostic Interview Schedule ( DIS ) . RESULTS The population of homeless women in St. Louis is predominantly young adult , single , and black ; most have young children and average nearly a high school education . Schizophrenia and bipolar affective disorder account for only a small portion of the mental illness in these women . Nearly one in three has a history of substance abuse , with drug abuse being more prevalent than alcoholism . One third of the sample met lifetime criteria for posttraumatic stress disorder . One fourth of the women have received  inpatient psychiatric care  , and the majority with a nonsubstance Axis I diagnosis have received some  mental health treatment .  CONCLUSION Although major mental illness is overrepresented among these homeless women , the majority do not suffer from major mental illness . Despite the severity of the stressors these women face , the large numbers escaping psychiatric disorders speak to their resilience and to the likelihood that important factors other than mental illness contribute to their homelessness . Future studies to examine positive outcomes and investigate protective factors might provide a valuable source of information on coping with the stresses associated with homelessness and point to more effective interventions PURPOSE Anxiety and depressive disorders have been established as independent risk factors for the development of and recovery from coronary heart disease ( CHD ) . However , few studies have reported on the prevalence and personal characteristics of comorbid psychiatric disorders ( PD ) among cardiac population s. This project examined the prevalence of comorbid depressive and anxiety disorders among men and women with CHD commencing cardiac rehabilitation ( CR )  and the demographic , medical , and psychosocial characteristics among those meeting multiple PD criteria . METHODS Participants were 143 CHD patients ( M age , 61 years ; SD , 11.2 ; 70 % men , 91 % Caucasian , 64 % married ) entering CR who were evaluated via a semistructured , psychiatric interview to assess both current and lifetime prevalence rates of PD . Demographic , medical , and psychosocial variables were also assessed . RESULTS Approximately 45 % met criteria for at least 1 anxiety disorder , and 20 % met criteria for either major depressive disorder or dysthymic disorder either at the time of evaluation or in their lifetime . Across all participants , 26 % met criteria for ≥2 PD . Of those with a depressive disorder , 76 % also met criteria for at least 1 anxiety disorder . Participants with comorbid PD were of younger age and female and reported less education ( P < .01 ) . Comorbidity was also associated with self-reported overall diminished physical , emotional , and social quality of life , depression , and anxiety . CONCLUSION Comorbid PD are highly prevalent in the CR setting and are associated with specific demographic characteristics and reduced quality of life . These data offer additional support that routine screening for PD is warranted in outpatient cardiac setting OBJECTIVE The prevalence of lifetime alcohol abuse and /or dependence ( alcoholism ) in patients with bipolar disorder has been reported to be higher than in all other axis I psychiatric diagnoses . This study examined gender-specific relationships between alcoholism and bipolar illness , which have previously received little systematic study . METHOD The prevalence of lifetime alcoholism in 267 out patients enrolled in the Stanley Foundation Bipolar Network was evaluated by using the Structured Clinical Interview for DSM-IV .  Alcoholism and its relationship to retrospectively assessed measures of the course of bipolar illness were evaluated by patient-rated and clinician-administered question naires . RESULTS As in the general population , more men ( 49 % , 57 of 116 ) than women with bipolar disorder ( 29 % , 44 of 151 ) met the criteria for lifetime alcoholism . However , the risk of having alcoholism was greater for women with bipolar disorder ( odds ratio=7.35 ) than for men with bipolar disorder ( odds ratio=2.77 ) , compared with the general population . Alcoholism was associated with a history of polysubstance use in women with bipolar disorder and with a family history of alcoholism in men with bipolar disorder . CONCLUSIONS This study suggests that there are gender differences in the prevalence , risk , and clinical correlates of alcoholism in bipolar illness . Although this study is limited by the retrospective assessment of illness variables , the magnitude of these gender-specific differences is substantial and warrants further prospect i ve study BACKGROUND Psychiatric history has been suggested to have an impact on long-term adjustment in burn survivors . A rigorous , prospect i ve , longitudinal approach was used to study psychiatric history in a population -based burn sample and its impact on symptomatology of depression and posttraumatic stress disorder ( PTSD ) at a 12-month follow-up . METHODS Seventy-three consecutive patients admitted to the Uppsala Burn Unit were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition for psychiatric disorders , of whom 64 were also assessed after 12 months . RESULTS Forty-eight patients ( 66 % ) presented with at least one lifetime psychiatric diagnosis ; major depression ( 41 % ) , alcohol abuse or dependence ( 32 % ) , simple phobia ( 16 % ) , and panic disorder ( 16 % ) were most prevalent . At 12-months postburn , 10 patients ( 16 % ) met criteria for major depression , 6 ( 9 % ) for PTSD , and 11 ( 17 % ) for subsyndromal PTSD . Patients with lifetime anxiety disorder and with lifetime psychiatric comorbidity were more likely to be depressed at 12 months , whereas those with lifetime affective disorder , substance use disorder and psychiatric comorbidity were more likely to have symptoms of PTSD . CONCLUSIONS Two-thirds of burn survivors exhibit a history of lifetime psychiatric disorders . Those with a psychiatric history have a higher risk of postburn psychiatric problems OBJECTIVE The authors sought to observe the long-term clinical course of anxiety disorders over 12 years and to examine the influence of comorbid psychiatric disorders on recovery from or recurrence of panic disorder , generalized anxiety disorder , and social phobia . METHOD Data were drawn from the Harvard/Brown Anxiety Disorders Research Program , a prospect i ve , naturalistic , longitudinal , multicenter study of adults with a current or past history of anxiety disorders . Probabilities of recovery and recurrence were calculated by using st and ard survival analysis methods . Proportional hazards regression analyses with time-varying covariates were conducted to determine risk ratios for possible comorbid psychiatric predictors of recovery and recurrence . RESULTS Survival analyses revealed an overall chronic course for the majority of the anxiety disorders . Social phobia had the smallest probability of recovery after 12 years of follow-up . Moreover , patients who had prospect ively observed recovery from their intake anxiety disorder had a high probability of recurrence over the follow-up period . The overall clinical course was worsened by several comorbid psychiatric conditions , including major depression and alcohol and other substance use disorders , and by comorbidity of generalized anxiety disorder and panic disorder with agoraphobia . CONCLUSIONS These data depict the anxiety disorders as insidious , with a chronic clinical course , low rates of recovery , and relatively high probabilities of recurrence . The presence of particular comorbid psychiatric disorders significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence . The findings add to the underst and ing of the nosology and treatment of these disorders Recent studies emphasize the negative impact of comorbidity on the course of depression . If undiagnosed , depression and comorbidity contribute to high medical utilization . We aim ed to assess ( 1 ) prevalences of depression alone and with comorbidity ( anxiety/somatoform disorders ) in primary care , ( 2 ) coexistence of anxiety/somatoform disorders in depressive patients , and ( 3 ) diagnostic validity of two screeners regarding depression with versus without comorbidity . We examined 394 primary care out patients using the Composite International Diagnostic Interview ( CIDI ) , the  General Health Question naire (  GHQ-12  ) , and the Well-Being Index ( WHO-5  ) . We conducted configurational frequency analyses to identify nonr and om configurations of the disorders and receiver operating characteristic (ROC)-analyses to assess diagnostic validity of the screeners . Point prevalence of any depressive disorder was 22.8 % ; with at least one comorbid disorder , 15 % ; and with two comorbid conditions , 6.1 % , which significantly exceeded expected percentage ( 0.9 % , P < or = .0001 ) . Depression without comorbidity occurred significantly less often than expected by chance ( P < or = .0007 ) . Comorbidity of depressive and anxiety or somatoform disorders was associated with a high odds ratio ( 6.25 ) . The screeners were comparable regarding their diagnostic validity for depression with [ GHQ-12 : area under the curve (AUC)=0.86 ; WHO-5 : AUC=0.88 ] and without comorbidity ( GHQ-12 : AUC=0.84 ; WHO-5 : AUC=0.86 ) . It can be concluded that comorbidity between depression and anxiety/somatoform disorders in primary care may occur much more frequently than expected . These results confirm assumptions that the current division between depression and anxiety might be debatable . Validity of screeners tested in our study was not affected by comorbid conditions ( e.g. , anxiety or somatoform disorders ) 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 OBJECTIVE To evaluate the prevalence of substance abuse dependence and /or alcohol abuse dependence among subjects with bipolar I versus bipolar II disorder in a voluntary registry . METHOD One hundred r and omly selected registrants in a voluntary case registry for bipolar disorder were interviewed , using the Structured Clinical Interview for DSM-IV Axis I Disorders , to vali date the diagnosis of this registry . Corroborative information was obtained from medical records , family members and the treating psychiatrist . Eighty-nine adults ( 18 - 65 years ) met criteria for bipolar disorder ( bipolar I = 71 , bipolar II = 18 ) and were included in this analysis . RESULTS Forty-one ( 57.8 % ) subjects with bipolar I disorder abused , or were dependent on one or more substances or alcohol , 28.2 % abused , or were dependent on , two substances or alcohol , and 11.3 % abused or were dependent on three or more substances or alcohol . Nearly 39 % of bipolar II subjects abused or were dependent on one or more substances , nearly 17 % were dependent on two or more substances or alcohol , and 11 % were dependent on three or more substances or alcohol . Alcohol was the most commonly abused drug among either bipolar I or II subjects . CONCLUSIONS Consistent with other epidemiologic and hospital population studies , this voluntary bipolar disorder registry suggests a high prevalence of comorbidity with alcohol and /or substance abuse dependence . Bipolar I subjects appear to have higher rates of these comorbid conditions than bipolar II subjects ; however , as the number of bipolar II subjects was rather small , this suggestion needs confirmation 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 OBJECTIVE Growing evidence of an etiologic overlap between schizophrenia , schizoaffective disorder , and bipolar disorder has become increasingly difficult to disregard . We investigated the magnitude of the overlap between the clinical diagnoses of bipolar affective disorder , schizoaffective disorder , and schizophrenia over a 35-year period based on the entire Danish population . METHOD We established a  register-based prospect i ve cohort study of more than 2.5 million persons born in Denmark after 1954 . Risks for the 3 psychiatric disorders were estimated by survival analysis using the Aalen-Johansen method . Cohort members were followed from 1970 to 2006 . We introduced a new comorbidity index measuring the magnitude of the overlap between the 3 disorders . RESULTS Overall , 12,734 patients were admitted with schizophrenia , 4,205 with bipolar disorder , and 1,881 with schizoaffective disorder . A female bipolar patient 's risk of also being admitted with a schizoaffective disorder by the age of 45 years was approximately 103 times higher than that of a woman at the same age in the general population . Thus , we defined the comorbidity index between schizoaffective disorder and bipolar disorder at age 45 years to be 103 . At age 45 years , the index between schizophrenia and schizoaffective disorder was 80 and between schizophrenia and bipolar disorder was 20 . Similar large comorbidity indexes were found for men . CONCLUSIONS A large comorbidity index between schizophrenia and schizoaffective disorder was found , as well as a large index between bipolar disorder and schizoaffective disorder . But , more surprisingly , it was clear that a substantial comorbidity index between bipolar disorder and schizophrenia was present . This study supports the existence of an overlap between bipolar disorder and schizophrenia and thus challenges the strict categorical approach used in both DSM-IV and ICD-10 classification systems Abstract OBJECTIVES : To define the spectrum of chronic noncancer pain treated with opioid medications  in 2 primary care setting s , and the prevalence of psychiatric comorbidity in this patient population . We also sought to determine the proportion of patients who manifested prescription opioid abuse behaviors and the factors associated with these behaviors . DESIGN : A retrospective cohort study . SETTING : A VA primary care clinic and an urban hospital-based primary care center ( PCC ) located in the northeastern United States . PATIENTS : A r and om sample of VA patients ( n=50 ) and all PCC patients ( n=48 ) with chronic noncancer pain who received 6 or more months of opioid prescriptions during a 1-year period ( April 1 , 1997 through March 31 , 1998 ) and were not on methadone maintenance .  MEASUREMENTS : Information regarding patients ’ type of chronic pain disorder , demographic , medical , and psychiatric status , and the presence of prescription opioid abuse behaviors was obtained by medical record review . MAIN RESULTS : Low back pain was the most common disorder accounting for 44 % and 25 % of all chronic pain diagnoses in the VA and PCC sample s , respectively , followed by injury-related ( 10 % and 13 % ) , diabetic neuropathy ( 8 % and 10 % ) , degenerative joint disease ( 16 % and 13 % ) , spinal stenosis ( 10 % and 4 % ) , headache ( 4 % and 13 % ) and other chronic pain disorders ( 8 % and 22 % ) . The median duration of pain was 10 years ( range 3 to 50 years ) in the VA and 13 years in the PCC sample ( range 1 to 49 years ) . Among VA and PCC patients , the lifetime prevalence rates of psychiatric comorbidities were : depressive disorder ( 44 % and 54 % ) , anxiety disorder ( 20 % and 21 % ) , alcohol abuse/dependence ( 46 % and 31 % ) , and narcotic abuse/dependence ( 18 % and 38 % ) . Prescription opioid abusive behaviors were recorded for 24 % of VA and 31 % of PCC patients . A lifetime history of a substance use disorder ( adjusted odds ratio [ OR ] , 3.8 ; 95 % confidence interval [ CI ] , 1.4 to 10.8 ) and age ( adjusted OR , 0.94 ; 95 % CI , 0.89 to 0.99 ) were independent predictors of prescription opioid abuse behavior . CONCLUSIONS : A broad spectrum of chronic noncancer pain disorders are treated with opioid medications in primary care setting s. The lifetime prevalence of psychiatric comorbidity was substantial in our study population . A significant minority of patients manifested prescription opioid abusive behaviors , and a lifetime history of a substance use disorder and decreasing age were associated with prescription opioid abuse behavior . Prospect i ve studies are needed to determine the potential benefits as well as risks associated with opioid use for chronic noncancer pain in primary care BACKGROUND The treatment of bipolar disorder is often complicated by the presence of a co-occuring anxiety disorder . Although second generation antipsychotics are being used with increasing frequency in bipolar patients , their anxiolytic effects have not been well studied in this population . METHODS The anxiolytic effect of risperidone 0.5 - 4 mg/day was tested in an 8-week , double-blind , placebo-controlled , r and omized clinical trial in 111 patients with bipolar disorder and a co-occuring panic disorder or generalized anxiety disorder ( GAD ) . The primary outcome measure was the Clinician Global Improvement-21 Anxiety scale ( CGI-21 Anxiety ) . Secondary measures included the Hamilton Anxiety Scale ( HAM-A ) and the Sheehan Panic Disorder Scale . RESULTS On the last-observation-carried forward analysis of repeated measures analysis of variance ( ANOVA ) , risperidone was not more effective than placebo for the CGI-21 Anxiety score or the other anxiety outcome measures .  Risperidone was well tolerated , with only two patients withdrawing because of adverse events . LIMITATIONS The  risperidone treated group had more patients with mixed states and lifetime panic disorder at r and omization than the placebo group . The study was limited to 8 weeks and to individuals with bipolar and comorbid panic disorder or GAD . The results may not be applicable to risperidone as an add-on treatment to mood stabilizers , or to bipolar disorder comorbid with anxiety disorders other than panic disorder or GAD . CONCLUSIONS Risperidone monotherapy was not an effective anxiolytic for bipolar patients with comorbid panic disorder or GAD in doses of 0.5 - 4 mg/day over 8 weeks of treatment . The efficacy of other second generation antipsychotics and mood stabilizers on anxiety in patients with bipolar disorder and a co-occuring anxiety disorder should be investigated in double-blind , placebo-controlled studies OBJECTIVE Major depression occurs with generalized anxiety disorder and panic disorder in up to 60 % of psychiatric and primary care patients . This comorbidity has been associated with greater severity of depression , poorer psychosocial functioning , and poorer treatment outcomes in psychiatric sample s. This study examined the clinical outcomes for depressed primary care patients with and without a lifetime anxiety disorder . METHOD A total of 157 primary care patients who met criteria for major depression were r and omly assigned to st and ardized interpersonal psychotherapy or pharmacotherapy with nortriptyline and were assessed at baseline and at 4 and 8 months on severity of depression , psychosocial functioning , and health-related functioning . RESULTS Depressed patients with a comorbid anxiety disorder presented with significantly more psychopathology and tended to prematurely terminate treatment more frequently than patients with major depression alone . Both st and ardized depression-specific treatments were effective for depressed patients with and without a comorbid generalized anxiety disorder , although time to recovery was longer for the former . Patients with lifetime panic disorder showed poor recovery in response to psychotherapy or pharmacotherapy . CONCLUSIONS St and ardized psychotherapy and pharmacotherapy are effective for patients with major depression with and without a generalized anxiety disorder . However , the longer time to recovery for the former group and lack of response to these treatments by patients with lifetime panic disorder suggest that primary care physicians should carefully assess history of anxiety disorder among depressed patients so as to select a proper intervention Background Bipolar disorder is highly recurrent and rates of comorbidity are high . Studies have pointed to anxiety comorbidity as one factor associated with risk of suicide attempts and poor overall outcome . This study aim ed to explore the feasibility and potential benefits of a new psychological treatment ( Mindfulness-based Cognitive Therapy : MBCT ) for people with bipolar disorder focusing on between-episode anxiety and depressive symptoms . Methods The study used data from a pilot r and omized trial of MBCT for people with bipolar disorder in remission , focusing on between-episode anxiety and depressive symptoms . Immediate effects of MBCT versus waitlist on levels of anxiety and depression were compared between unipolar and bipolar participants . Results The results suggest that MBCT led to improved immediate outcomes in terms of anxiety which were specific to the bipolar group . Both bipolar and unipolar participants allocated to MBCT showed reductions in residual depressive symptoms relative to those allocated to the waitlist condition . Limitations Analyses were based on a small sample , limiting power . Additionally the study recruited participants with suicidal ideation or behaviour so the findings can not immediately be generalized to individuals without these symptoms . Conclusions The study , although preliminary , suggests an immediate effect of MBCT on anxiety and depressive symptoms among bipolar participants with suicidal ideation or behaviour , and indicates that further research into the use of MBCT with bipolar patients may be warranted Abstract Prior studies of careseeking fibromyalgia ( FM ) patients often report that they have an elevated risk of psychiatric disorders , but biased sampling may distort true risk . The current investigation utilizes state‐of‐the‐art diagnostic procedures for both FM and psychiatric disorders to estimate prevalence rates of FM and the comorbidity of FM and specific psychiatric disorders in a diverse community sample of women . Participants were screened by telephone for  FM and MDD , by r and omly selecting telephone numbers from a list of households with women in the NY/NJ metropolitan area . Eligible women were invited to complete physical examinations for FM and clinician‐administered psychiatric interviews . Data were weighted to adjust for sampling procedures and population demographics . The estimated overall prevalence of FM among women in the NY/NJ metropolitan area was 3.7 % ( 95 % CI = 3.2 , 4.4 ) , with higher rates among racial minorities .  Although risk of current MDD was nearly 3‐fold higher in community women with than without FM , the groups had similar risk of lifetime MDD . Risk of lifetime anxiety disorders , particularly obsessive compulsive disorder and post‐traumatic stress disorder , was approximately 5‐fold higher among women with FM . Overall , this study found a community prevalence for FM among women that replicates prior North American studies , and revealed that FM may be even more prevalent among racial minority women . These community‐based data also indicate that the relationship between MDD and FM may be more complicated than previously thought , and call for an increased focus on anxiety disorders in FM OBJECTIVE Although studies have suggested that comorbid medical illness can affect the outcome of patients with depression , little is known about whether medical illness comorbidity affects treatment outcome in patients with anxiety . METHOD Primary care patients with panic disorder ( n=232 ) , participating in a r and omized collaborative care intervention of CBT and pharmacology  , were divided into those above ( n=125 ) and below ( n=107 ) the median for burden of chronic medical illness and assessed at 3 , 6 , 9 and 12 months . RESULTS Subjects with a greater burden of medical illness were more psychiatrically ill at baseline , with greater anxiety symptom severity , greater disability and more psychiatric comorbidity . The intervention produced significant and similar increases in amount of evidence -based care , and reductions in clinical symptoms and disability that were comparable in the more and less medically ill groups . CONCLUSIONS The comparable response of individuals with more severe medical illness suggests that CBT and pharmacotherapy for panic disorder work equally well regardless of medical illness comorbidity . However , the more severe psychiatric illness both at baseline and follow-up in these same individuals suggest that treatment programs may need to be extended in time to optimize treatment outcome Abstract BACKGROUND : Persons with persistent mental illness are at risk for failure to receive medical services . In order to deliver appropriate preventive and primary care for this population , it is important to determine which chronic medical conditions are most common . OBJECTIVE : We examined chronic medical comorbidity in persons with schizophrenia using vali date d method ologies . DESIGN : Retrospective analysis of longitudinal administrative cl aims data from Wellmark Blue Cross/Blue Shield of Iowa . PARTICIPANTS : Subjects with schizophrenia or schizoaffective disorder ( N=1,074 ) , and controls ( N=726,262 ) who filed at least 1 cl aim for medical services , 1996 to 2001 . MEASUREMENTS : Case subjects had schizophrenia as the most clinical ly predominant psychotic disorder , based on psychiatric hospitalization , psychiatrist diagnoses , and outpatient care . Controls had no cl aims for any psychiatric comorbidity . Using a modified version of the Elixhauser Comorbidity Index , inpatient and outpatient cl aims were used to determine the prevalence of 46 common medical conditions . Odds ratios ( ORs ) were adjusted for age , gender , residence , and nonmental health care utilization using logistic regression . RESULTS : Subjects with schizophrenia were significantly more likely to have 1 or more chronic conditions compared with controls . Adjusted OR ( 95 % confidence interval [ CI ] ) were 2.62 ( 2.09 to 3.28 ) for hypothyrodisim , 1.88 ( 1.51 to 2.32 ) for chronic obstructive pulmonary disease , 2.11 ( 1.36 to 3.28 ) for diabetes with complications , 7.54 ( 3.55 to 15.99 ) for hepatitis C , 4.21 ( 3.25 to 5.44 ) for fluid/electrolyte disorders , and 2.77 ( 2.23 to 3.44 ) for nicotine abuse/dependence . CONCLUSIONS : Schizophrenia is associated with substantial chronic medical burden . Familiarity with conditions affecting persons with schizophrenia may assist programs aim ed at providing medical care for the mentally ill 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
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 .