Alcoholism and anxiety in bipolar illness: Differential lifetime anxiety comorbidity in bipolar I women with and without alcoholism

Department of Psychiatry, Ludwig-Maximilians-University of Munich, München, Bavaria, Germany
Journal of Affective Disorders (Impact Factor: 3.38). 09/2007; 101(1-3):211-7. DOI: 10.1016/j.jad.2006.11.023
Source: PubMed


This study was undertaken to evaluate the prevalence rate of anxiety comorbidity in bipolar subjects with and without alcohol use disorders (AUD).
Bipolar men and women who entered the Stanley Foundation Bipolar Network (SFBN) underwent a Structured Clinical Interview for DSM-IV (SCID-IV) and were divided into those subjects meeting current or lifetime criteria for an alcohol use disorder (AUD=213) vs. those subjects who did not (non-AUD=137). Lifetime rates of comorbid anxiety disorder were evaluated between groups.
Of 350 subjects, 163 (46.5%) met criteria for an anxiety disorder. Panic disorder and OCD were the most common anxiety disorders in the AUD and non-AUD groups. OCD and specific phobia were significantly less prevalent in BP I patients with AUD compared to those without. Bipolar women with AUD had a significantly higher rate of PTSD than those without.
These data highlight the added liability of anxiety comorbidity in BP disorder. Specifically, the greater amount of PTSD and lesser amount of OCD in bipolar women with alcohol comorbidity may have important diagnostic and treatment implications beyond dual diagnosis. Further study in comorbidity patterns is encouraged to not only better understand illness burden, but to maximize pattern-specific treatment outcomes.

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    • "Comorbidity between bipolar disorder and alcohol use disorder (AUD) is exceptionally high, with more than 50% of the individuals with bipolar disorder receiving an AUD diagnosis in their lifetimes [33] [48]. As comorbid AUD worsens so does the course of mental illnesses, which in turn complicates treatment response [8], therefore, clarifying the nature of the relationship between bipolar disorder and AUD could improve clinical outcomes. "
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    ABSTRACT: Bipolar disorder and alcohol use disorder (AUD) have a high rate of comorbidity, more than 50% of individuals with bipolar disorder also receive a diagnosis of AUD in their lifetimes. Although both disorders are heritable, it is unclear if the same genetic factors mediate risk for bipolar disorder and AUD. We examined 733 Costa Rican individuals from 61 bipolar pedigrees. Based on a best estimate process, 32% of the sample met criteria for bipolar disorder, 17% had a lifetime AUD diagnosis, 32% met criteria for lifetime nicotine dependence, and 21% had an anxiety disorder. AUD, nicotine dependence and anxiety disorders were relatively more common among individuals with bipolar disorder than in their non-bipolar relatives. All illnesses were shown to be heritable and bipolar disorder was genetically correlated with AUD, nicotine dependence and anxiety disorders. The genetic correlation between bipolar and AUD remained when controlling for anxiety, suggesting that unique genetic factors influence the risk for comorbid bipolar and AUD independent of anxiety. Our findings provide evidence for shared genetic effects on bipolar disorder and AUD risk. Demonstrating that common genetic factors influence these independent diagnostic constructs could help to refine our diagnostic nosology.
    European Psychiatry 12/2013; 29(5). DOI:10.1016/j.eurpsy.2013.10.001 · 3.44 Impact Factor
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    • "It is not surprising, then, that bipolar patients, with or without cooccurring alcohol use disorders, have very high rates of additional psychiatric problems (McElroy et al., 2001). Work on this topic has increasingly focused on the particular combination of bipolar, substance use, and anxiety disorders (Simon et al., 2004a; Kolodziej et al., 2005; Levander et al., 2007; Goldstein and Levitt, 2008; Gao et al., 2010). Simon et al. (2004a, 2004b) demonstrated that 40% of bipolar patients with alcohol dependence from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were diagnosed with at least one current anxiety disorder. "
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    ABSTRACT: Despite the high prevalence and detrimental impact of alcoholism on bipolar patients, the diagnostic and treatment factors associated with better or worse clinical outcomes in alcohol-dependent patients with bipolar disorder are not well understood. The present study investigated the prospective impact of baseline psychiatric comorbidities and treatment regimens on clinical outcomes in bipolar alcoholics. Data were drawn from an 8-week randomized controlled clinical trial of acamprosate for individuals (n=30) with co-occurring bipolar disorder and alcohol dependence. Depressive and manic symptoms, and alcohol craving and consumption were monitored longitudinally using standardized instruments. Path analysis was used to estimate the prospective associations between patient characteristics and outcomes. More than 50% of patients were diagnosed with at least one anxiety (76.7%) or drug dependence disorder (60.0%). Comorbid anxiety disorders were prospectively associated with increased depressive symptoms and alcohol use. Participants were prescribed an average of 2.6 psychotropic medications at baseline. Antipsychotics and anticonvulsants were prospectively associated with increased alcohol use; anticonvulsants and benzodiazepines were associated with increased alcohol craving. Antidepressants were associated with increased depressive symptoms. Conversely, lithium was associated with decreased alcohol craving and depressive symptoms. The findings from the present study suggest areas for future research in this population.
    Psychiatry Research 06/2011; 188(3):361-5. DOI:10.1016/j.psychres.2011.04.030 · 2.47 Impact Factor
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    • "Chronic medical illnesses were associated with a more severe course of bipolar disorder, increased household and work maladjustment , receipt of disability payments, reduced employment, and more frequent medical service utilization (McIntyre et al 2006). On the other hand, different studies have shown the high prevalence and negative impact of comorbid alcoholism and anxiety disorders in bipolar subjects (Winokur et al 1995; Sasson et al 2003; Levander et al 2007). Bipolar subjects with a history of comorbid alcohol use disorder are more likely to meet criteria for an axis II diagnosis based on the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID II) compared with bipolar subjects without an alcohol use disorder history (Winokur et al 1995). "
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    ABSTRACT: Outcome in bipolar patients is affected by comorbidity. Comorbid personality disorders are frequent and may complicate the course of bipolar illness. This pilot study examined a series of 40 euthymic bipolar patients (DSM-IV criteria) (bipolar I disorder 31, bipolar II disorder 9) to assess the effect of clinical variables and the influence of comorbid personality on the clinical course of bipolar illness. Bipolar patients with a diagnosis of comorbid personality disorder (n = 30) were compared with "pure" bipolar patients (n = 10) with regard to demographic, clinical, and course of illness variables. Comorbid personality disorder was diagnosed in 75% of patients according to ICD-10 criteria, with obsessive-compulsive personality disorder being the most frequent type. Sixty-three per cent of subjects had more than one comorbid personality disorder. Bipolar patients with and without comorbid personality disorder showed no significant differences regarding features of the bipolar illness, although the group with comorbid personality disorder showed a younger age at onset, more depressive episodes, and longer duration of bipolar illness. In subjects with comorbid personality disorders, the number of hospitalizations correlated significantly with depressive episodes and there was an inverse correlation between age at the first episode and duration of bipolar illness. These findings, however, should be interpreted taking into account the preliminary nature of a pilot study and the contamination of the sample with too many bipolar II patients.
    Neuropsychiatric Disease and Treatment 05/2007; 3(2):269-75. DOI:10.2147/nedt.2007.3.2.269 · 1.74 Impact Factor
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