The Anxiety-Bipolar Connection

Department of Psychiatry, Pharmacology, Neurobiology and Bio-technology,
University of Pisa, via Roma 67, 56100 Pisa, Italy. s.pini@psico.med.unipi.it

BACKGROUND: The present study examined whether specific types of comorbid
anxiety disorders, namely panic disorder (PD), social phobia (SP) and
obsessive-compulsive disorder (OCD) are differentially associated with course
variables and insight into bipolar illness. METHOD: The sample consisted of 151
consecutively hospitalized patients with bipolar I disorder. They were assessed
in the week prior to discharge using the Structured Clinical Interview for
DSM-III-R (SCID-P), the Brief Psychiatric Rating Scale (BPRS), the Global
Assessment of Functioning Scale (GAF) and the Hopkins Symptom Checklist
(HSCL-90). Level of insight was assessed with the Scale to assess Unawareness of
Mental Disorders (SUMD). RESULTS: Of the 151 bipolar subjects, 92 had no PD, SP
and OCD comorbidity, 35 had PD and 24 had SP and/or OCD. The three groups
differed significantly on the current awareness of illness and treatment
response scores and the retrospective awareness of illness and treatment
response scores. Post-hoc analyses revealed that, compared with bipolar patients
without PD/SD/OCD and those with comorbid PD, patients with comorbid SP and/or
OCD had better insight on current awareness of illness, current awareness of
treatment response, retrospective awareness of illness and retrospective
awareness of treatment response. The regression analysis showed that the
presence of no panic type anxiety comorbidity was a predictor of good insight.
CONCLUSIONS: These data indicate the value of identifying comorbid anxiety
disorders in patients with bipolar illness. The results could be interpreted as
evidence of discrete disorders within the bipolar spectrum, one that is
characterized by, among other things, SP and/or OCD with good insight, another
characterized by PD with poor insight.