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 .
Early stages in the development of bipolar disorder.
BACKGROUND Numerous studies have observed that offspring of bipolar parents manifest a broad spectrum of psychiatric disorders . We tested the hypothesis that in high risk offspring , bipolar disorder evolves in a predictable clinical sequence from non-specific ( non-mood ) to specific ( mood ) psychopathology . METHODS Offspring from well-characterized families with one bipolar parent ( high risk ) or two well parents ( controls ) were assessed annually or at anytime symptoms developed using KSADS-PL interviews for up to 15 years . DSM-IV diagnoses were made on blind consensus review using all available clinical material . We compared the age-adjusted risks of lifetime psychopathology between high risk and control subjects and assessed the conditional probability of developing a mood disorder given a history of non-mood disorders . In subjects meeting full DSM-IV criteria for bipolar disorder , we assessed the sequence of psychopathology against a clinical staging model . RESULTS High risk offspring manifest higher rates of anxiety and sleep disorders , as well as major mood and substance use disorders compared to controls . Antecedent anxiety increased the age-adjusted risk of mood disorder from 40 to 85 % ( hazard ratio of 2.6 ) . High risk subjects who developed a mood disorder had an increased risk of a substance use disorder ( hazard ratio of 2.4 ) , typically meeting diagnostic criteria during or after the first major mood episode . The evolution of psychopathology leading to bipolar disorder generally followed the proposed sequence , although not all subjects manifest all stages . LIMITATIONS Larger numbers of high risk offspring prospect ively assessed over the risk period would allow confirmation of these preliminary findings . CONCLUSIONS Clinical staging may be a useful approach to refine the early diagnosis and facilitate research into the evolution of bipolar disorder in those at familial risk
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 .