Anxiety prevalent in children with bipolar disorder
MedWire News: Anxiety disorders affect nearly half of young people with bipolar disorder, and often predate the onset of bipolar disorder, research shows.
"Some of the most common comorbid disorders among youth with bipolar disorder are the anxiety disorders," explain Regina Sala (University of Pittsburgh, Pennsylvania, USA) and team.
"Since anxiety disorders are also accompanied by significant impairment in psychosocial functioning of the child, it is important to evaluate the prevalence and clinical correlates of the association between bipolar disorder and anxiety in youth," they add.
The team therefore studied 446 young people, aged between 7 and 17 years, with bipolar spectrum disorders who participated in the Course and Outcome of Bipolar Youth study. Of these, 260 had bipolar I disorder, 32 had bipolar II disorder, and 154 had bipolar disorder not otherwise specified (NOS).
All of the children were assessed at baseline for Axis I psychiatric disorders using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime version.
Participants were considered positive for the presence of a lifetime anxiety disorder if they met full criteria for at least one of the following: separation anxiety disorder, generalized anxiety disorder (GAD), obsessive compulsive disorder, post-traumatic stress disorder, social phobia, panic disorder, anxiety disorder NOS, or agoraphobia.
The researchers found that, overall, 44% of the participants met criteria for at least one lifetime anxiety disorder, while 20% met criteria for two or more. The most common of these disorders were separation anxiety disorder (24%) and GAD (16%).
Anxiety disorders were significantly more common in participants with bipolar II disorder (69%) than in those with bipolar I disorder (41%) or bipolar disorder NOS (41%).
After accounting for socioeconomic status, age at bipolar disorder onset, and other potential confounding factors, the researchers found that the presence of a lifetime anxiety disorder was significantly associated with bipolar II disorder (odds ratio[OR]=2.34), longer duration of mood symptoms (OR=1.11), fewer manic episodes (OR=0.38), and higher rates of depression among first- and second-degree relatives (OR=3.58).
Participants with a comorbid anxiety disorder also had more severe depression symptoms and feelings of hopelessness than those without anxiety disorders.
Furthermore, the researchers found that 79% of participants with an anxiety disorder developed the condition before the onset of bipolar disorder.
Sala and team conclude in the Journal of Clinical Psychiatry: "Anxiety disorders usually predate the onset of bipolar disorder and are very common in youth with bipolar disorder, especially those with bipolar II disorder, longer duration of mood symptoms, more severe depression, and family history of depression."
They add: "Given the clinical and treatment implications of these findings, early identification and accurate diagnosis for these youth is very important."
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By Mark Cowen