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A Journal on Psychiatry, Psychology and Psychopharmacology

Official Journal of the Italian Society of Social Psychiatry
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Minerva Psichiatrica 2007 March;48(1):55-73


language: Italian

Comorbidity in bipolar and anxiety disorders

Bogetto F., Asinari G. F., Pessina E., Maina G.

Servizio per i Disturbi Depressivi e d’Ansia SCDU Psichiatria Dipartimento di Neuroscienze Università degli Studi di Torino, Torino


Although anxious morbidity has been historically reported as a fundamental feature of bipolar disorder, this feature has not been investigated until recent years. Previous investigation describing comorbidity in bipolar disorders have frequently reported on the staggering prevalence and clinical implication of comorbid alchohol and substance abuse. Recent investigations provide compelling evidence that anxiety disorders may be the most prevalent psychiatric comorbidity amongst person with bipolar disorder. Anxiety phenomenology often precedes and may hasten the onset of overt bipolar disorder. Moroeover, anxiety comorbidity poses a serious hazard to individuals with bipolar disorder, i.e. it is associated with an intensification of symptoms, insufficient treatment response, nonrecovery, poor functional outcome, increased comorbidity with substance abuse. Anxiety phenomenology in the individuals with bipolar disorder is associated with several indices of harmful dysfunction, notably suicidality. The epidemiological and clinical studies that have assessed the overlap of bipolar and anxiety disorders are reviewed, with focus on panic disorder and obsessive-compulsive disorder and to a lesser extent, social phobia, simple phobia, generalized anxiety disorder and post-traumatic stress disorder. Comorbid anxiety symptoms and disorders must be considered when diagnosing and treating patients with bipolar disorder. Conversely, patients presenting with anxiety disorders must be assessed for comorbid mood disorder, including bipolar disorder. However, several unanswered questions remain regarding the specificity and mechanism subserving the harmful effects of anxiety phenomenology.

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