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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    • "The self-report TEMPS-A questionnaire used in this study was the shortened 39-item version which only has 3 items for anxious temperament. This may represent a limitation, particularly considering the high prevalence of anxiety in concomitant BD with AM (Levander et al., 2007). There was no control group in this study (individuals without BD). "
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    ABSTRACT: Alcohol misuse (AM) is more common in bipolar disorder (BD) than within the general population but the mechanisms of this association are unclear. We hypothesized that certain affective temperaments (including hyperthymic, cyclothymic, anxious, depressive and/or irritability) might represent 'fundamental states' contributing to risk of both AM and BD and we aimed to assess whether extremes of these five affective temperaments were associated with BD and concomitant AM status. Our sample comprised 1420 individuals with BD who were recruited into a clinical-genetic study conducted by the Bipolar Disorder Research Network. Phenotypic assessments, including evaluation for AM and the 32-item TEMPS-A questionnaire, were conducted. Binary logistic regression was used to determine the effect of TEMPS-A scores on the likelihood of concomitant AM, with adjustment for confounders. Mean scores for four affective temperaments (hyperthymic, cyclothymic, depressive and irritable) were higher in cases (BD+AMs) than controls (BD only) (p<0.001). Hyperthymic and irritable temperaments in particular significantly increased the odds of concomitant AM within the BD sample after adjustment for potential confounders. The definition of AM was not directly based on formal diagnostic classification systems. A retrospective, cross-sectional design was used. Our findings may not generalize to other countries and cultures. Higher scores on measures of hyperthymic and irritable temperament may contribute to the association between AM and BD. Assessing affective temperaments early in the course of BD may help to predict the development of an AM problem in vulnerable individuals. Copyright © 2015. Published by Elsevier B.V.
    Journal of Affective Disorders 07/2015; 186:226-231. DOI:10.1016/j.jad.2015.07.027 · 3.38 Impact Factor
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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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