Anxiety Disorder Comorbidity in Bipolar Disorder, Schizophrenia and Schizoaffective DisorderYoung S.a · Pfaff D.a · Lewandowski K.E.a, b · Ravichandran C.a, b · Cohen B.M.a, b · Öngür D.a, b
aMcLean Hospital, Belmont, Mass., and bHarvard Medical School, Boston, Mass., USA
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Article / Publication Details
Background: Reported rates of comorbid anxiety disorders in psychotic and mood disorders vary widely among studies. Sampling and Methods: We used the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, to examine rates of comorbid anxiety disorders in patients with schizoaffective disorder (SZA; n = 153), bipolar I disorder (BP; n = 304) and schizophrenia (SZ; n = 174). Results: The rates of anxiety disorders in participants with SZA (30.1%), BP (22.4%) and SZ (16.7%) differed significantly [χ2(2) = 8.368, p = 0.015]. Among anxiety disorders, this effect was most pronounced for panic disorder (PD). PD rates were significantly higher in participants with SZA (15.7%) as compared to participants with BP (6.9%) and SZ [6.9%; χ2(2) = 10.879, p = 0.004]. Logistic regression models controlling for demographic and clinical characteristics confirmed that primary diagnosis (SZA, BP or SZ) was a significant predictor of PD comorbidity and approached significance in predicting the comorbidity of any anxiety disorder. Conclusions: Our findings suggest that patients with SZA have high rates of anxiety disorders. Clinicians treating patients with SZA should evaluate for anxiety disorder comorbidity, especially as anxiety symptoms may not be reported at first presentation.
© 2012 S. Karger AG, Basel
National Institute of Mental Health: Anxiety Disorders. (http://www.nimh.nih.gov/health/publications/anxiety-disorders/introduction.shtml). Accessed February 2, 2011.
- Kessler RC, Nelson CB, McGonagle KA, Liu J, Swartz M, Blazer DG: Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. Br J Psychiatry Suppl 1996;30:17-30.
- Regier DA, Kaelber CT, Roper MT, Rae DS, Sartorius N: The ICD-10 clinical field trial for mental and behavioral disorders: results in Canada and the United States. Am J Psychiatry 1994;151:1340-1350.
- Sanderson WC, DiNardo PA, Rapee RM, Barlow DH: Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder. J Abnorm Psychol 1990;99:308-312.
- Achim AM, Maziade M, Raymond E, Olivier D, Merette C, Roy MA: How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophr Bull 2011;37;811-821.
- Ciapparelli A, Paggini R, Marazziti D, Carmassi C, Bianchi M, Taponecco C, Consoli G, Lombardi V, Massimetti G, Dell'Osso L: Comorbidity with axis I anxiety disorders in remitted psychotic patients 1 year after hospitalization. CNS Spectr 2007;12:913-919.
- Simon NM, Otto MW, Wisniewski SR, Fossey M, Sagduyu K, Frank E, Sachs GS, Nierenberg AA, Thase ME, Pollack MH: Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry 2004;161:2222-2229.
- Vieta E, Colom F, Corbella B, Martinez-Aran A, Reinares M, Benabarre A, Gasto C: Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disord 2001;3:253-258.
- Bolton JM, Cox BJ, Afifi TO, Enns MW, Bienvenu OJ, Sareen J: Anxiety disorders and risk for suicide attempts: findings from the Baltimore Epidemiologic Catchment area follow-up study. Depress Anxiety 2008;25:477-481.
- Nepon J, Belik SL, Bolton J, Sareen J: The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depress Anxiety 2010;27:791-798.
- Strakowski SM, Keck PE Jr, McElroy SL, Lonczak HS, West SA: Chronology of comorbid and principal syndromes in first-episode psychosis. Compr Psychiatry 1995;36:106-112.
- Craig T, Hwang MY, Bromet EJ: Obsessive-compulsive and panic symptoms in patients with first-admission psychosis. Am J Psychiatry 2002;159:592-598.
- McElroy SL, Altshuler LL, Suppes T, Keck PE Jr, Frye MA, Denicoff KD, Nolen WA, Kupka RW, Leverich GS, Rochussen JR, Rush AJ, Post RM: Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. Am J Psychiatry 2001;158:420-426.
- Pini S, Cassano GB, Simonini E, Savino M, Russo A, Montgomery SA: Prevalence of anxiety disorders comorbidity in bipolar depression, unipolar depression and dysthymia. J Affect Disord 1997;42:145-153.
- Braga RJ, Petrides G, Figueira I: Anxiety disorders in schizophrenia. Compr Psychiatry 2004;45:460-468.
- Labbate LA, Young PC, Arana GW: Panic disorder in schizophrenia. Can J Psychiatry 1999;44:488-490.
- Cosoff SJ, Hafner RJ: The prevalence of comorbid anxiety in schizophrenia, schizoaffective disorder and bipolar disorder. Aust NZ J Psychiatry 1998;32:67-72.
- MacKinnon DF, Zandi PP, Cooper J, Potash JB, Simpson SG, Gershon E, Nurnberger J, Reich T, DePaulo JR: Comorbid bipolar disorder and panic disorder in families with a high prevalence of bipolar disorder. Am J Psychiatry 2002;159:30-35.
- Ongur D, Lin L, Cohen BM: Clinical characteristics influencing age at onset in psychotic disorders. Compr Psychiatry 2009;50:13-19.
- Ernst CL, Goldberg JF: Clinical features related to age at onset in bipolar disorder. J Affect Disord 2004;82:21-27.
- Lieberman JA, Safferman AZ, Pollack S, Szymanski S, Johns C, Howard A, Kronig M, Bookstein P, Kane JM: Clinical effects of clozapine in chronic schizophrenia: response to treatment and predictors of outcome. Am J Psychiatry 1994;151:1744-1752.
- Suominen K, Mantere O, Valtonen H, Arvilommi P, Leppamaki S, Paunio T, Isometsa E: Early age at onset of bipolar disorder is associated with more severe clinical features but delayed treatment seeking. Bipolar Disord 2007;9:698-705.
- Matheson SL, Green MJ, Loo C, Carr VJ: Quality assessment and comparison of evidence for electroconvulsive therapy and repetitive transcranial magnetic stimulation for schizophrenia: a systematic meta-review. Schizophr Res;118:201-210.
- Sienaert P, Vansteelandt K, Demyttenaere K, Peuskens J: Ultra-brief pulse ECT in bipolar and unipolar depressive disorder: differences in speed of response. Bipolar Disord 2009;11:418-424.
- Batki SL, Meszaros ZS, Strutynski K, Dimmock JA, Leontieva L, Ploutz-Snyder R, Canfield K, Drayer RA: Medical comorbidity in patients with schizophrenia and alcohol dependence. Schizophr Res 2009;107:139-146.
- Haro JM, Novick D, Suarez D, Alonso J, Lepine JP, Ratcliffe M: Remission and relapse in the outpatient care of schizophrenia: three-year results from the Schizophrenia Outpatient Health Outcomes study. J Clin Psychopharmacol 2006;26:571-578.
- Jaworski F, Dubertret C, Ades J, Gorwood P: Presence of co-morbid substance use disorder in bipolar patients worsens their social functioning to the level observed in patients with schizophrenia. Psychiatry Res 2011;185:129-134.
- Salyers MP, Mueser KT: Social functioning, psychopathology, and medication side effects in relation to substance use and abuse in schizophrenia. Schizophr Res 2001;48:109-123.
- Hettema JM, Neale MC, Kendler KS: A review and meta-analysis of the genetic epidemiology of anxiety disorders. Am J Psychiatry 2001;158:1568-1578.
- McLaughlin KA, Behar E, Borkovec TD: Family history of psychological problems in generalized anxiety disorder. J Clin Psychol 2008;64:905-918.
- Milne BJ, Caspi A, Harrington H, Poulton R, Rutter M, Moffitt TE: Predictive value of family history on severity of illness: the case for depression, anxiety, alcohol dependence, and drug dependence. Arch Gen Psychiatry 2009;66:738-747.
- Ongur D, Goff DC: Obsessive-compulsive symptoms in schizophrenia: associated clinical features, cognitive function and medication status. Schizophr Res 2005;75:349-362.
- Pallanti S, Quercioli L, Rossi A, Pazzagli A: The emergence of social phobia during clozapine treatment and its response to fluoxetine augmentation. J Clin Psychiatry 1999;60:819-823.
- Sagar R, Berry N, Sadhu R, Mishra S, Kahn DA: Clozapine-induced cardiomyopathy presenting as panic attacks. J Psychiatr Pract 2008;14:182-185.
- Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE: Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:617-627.
- Kendler KS, Walters EE, Neale MC, Kessler RC, Heath AC, Eaves LJ: The structure of the genetic and environmental risk factors for six major psychiatric disorders in women. Phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism. Arch Gen Psychiatry 1995;52:374-383.
- Tambs K, Czajkowsky N, Roysamb E, Neale MC, Reichborn-Kjennerud T, Aggen SH, Harris JR, Orstavik RE, Kendler KS: Structure of genetic and environmental risk factors for dimensional representations of DSM-IV anxiety disorders. Br J Psychiatry 2009;195:301-307.
- Bauer MS, Altshuler L, Evans DR, Beresford T, Williford WO, Hauger R: Prevalence and distinct correlates of anxiety, substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder. J Affect Disord 2005;85:301-315.
- Huppert JD, Smith TE: Anxiety and schizophrenia: the interaction of subtypes of anxiety and psychotic symptoms. CNS Spectr 2005;10:721-731.
- Young LT, Cooke RG, Robb JC, Levitt AJ, Joffe RT: Anxious and non-anxious bipolar disorder. J Affect Disord 1993;29:49-52.
- Lake C, Hurwitz N: Schizoaffective disorders are psychotic mood disorders: there are no schizoaffective disorders. Psychiatry Res 2006;143:255-287.
- Malhi GS, Green M, Fagiolini A, Peselow ED, Kumari V: Schizoaffective disorder: diagnostic issues and future recommendations. Bipolar Disord 2008;10:215-230.
Rowe R, Clark T: A survey of psychiatrists' attitudes to schizoaffective disorder. Int J Psychiatry Clin Pract 2008;12:25-30.
- Lencz T, Lipsky RH, DeRosse P, Burdick KE, Kane JM, Malhotra AK: Molecular differentiation of schizoaffective disorder from schizophrenia using BDNF haplotypes. Br J Psychiatry 2009;194:313-318.
- Craske MG, Rauch SL, Ursano R, Prenoveau J, Pine DS, Zinbarg RE: What is an anxiety disorder? Depress Anxiety 2009;26:1066-1085.
- Evans KC, Wright CI, Wedig MM, Gold AL, Pollack MH, Rauch SL: A functional MRI study of amygdala responses to angry schematic faces in social anxiety disorder. Depress Anxiety 2008;25:496-505.
- Rauch SL, Savage CR, Alpert NM, Fischman AJ, Jenike MA: The functional neuroanatomy of anxiety: a study of three disorders using positron emission tomography and symptom provocation. Biol Psychiatry 1997;42:446-452.
- Feske U, Frank E, Mallinger AG, Houck PR, Fagiolini A, Shear MK, Grochocinski VJ, Kupfer DJ: Anxiety as a correlate of response to the acute treatment of bipolar I disorder. Am J Psychiatry 2000;157:956-962.
- Frank E, Cyranowski JM, Rucci P, Shear MK, Fagiolini A, Thase ME, Cassano GB, Grochocinski VJ, Kostelnik B, Kupfer DJ: Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder. Arch Gen Psychiatry 2002;59:905-911.
- Braga RJ, Mendlowicz MV, Marrocos RP, Figueira IL: Anxiety disorders in outpatients with schizophrenia: prevalence and impact on the subjective quality of life. J Psychiatr Res 2005;39:409-414.
- Lysaker PH, Salyers MP: Anxiety symptoms in schizophrenia spectrum disorders: associations with social function, positive and negative symptoms, hope and trauma history. Acta Psychiatr Scand 2007;116:290-298.
- Ulas H, Alptekin K, Akdede BB, Tumuklu M, Akvardar Y, Kitis A, Polat S: Panic symptoms in schizophrenia: comorbidity and clinical correlates. Psychiatry Clin Neurosci 2007;61:678-680.
- Maina G, Albert U, Rosso G, Bogetto F: Olanzapine or lamotrigine addition to lithium in remitted bipolar disorder patients with anxiety disorder comorbidity: a randomized, single-blind, pilot study. J Clin Psychiatry 2008;69:609-616.
- Stern RG, Petti TA, Bopp K, Tobia A: Aripiprazole for the treatment of schizophrenia with co-occurring social anxiety: an open-label cross-taper study. J Clin Psychopharmacol 2009;29:206-209.
- Katzman MA, Brawman-Mintzer O, Reyes EB, Olausson B, Liu S, Eriksson H: Extended release quetiapine fumarate (quetiapine XR) monotherapy as maintenance treatment for generalized anxiety disorder: a long-term, randomized, placebo-controlled trial. Int Clin Psychopharmacol 2011;26:11-24.
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