Anxiety disorders comorbidity in bipolar disorder patients and quality of life

Abstract

Objective: Most of the previous studies evaluating patients with bipolar disorder showed that anxiety disorder comorbidity affects the appropriate treatment and the course of the disease. The aim of this study is to assess the lifetime and current anxiety disorder comorbidity prevalances and to compare clinical characteristics and quality of life among patients with and without comorbid anxiety disorder. Methods: 70 patients who were treated at Şişli Training and Research Hospital Psychiatry Department as outpatients or inpatients between January 2010 and May 2010 aged between 18-65 years and diagnosed as having bipolar I and II disorder according to DSM-IV-TR criteria, were included in the study. Sociodemographic form, SCID-I, Hamilton Depression and Anxiety scale, Young mania rating scale, SF-36 were applied to patients. Results: Current anxiety disorder comorbidity was found in 32.9% of the patients , the most common current comorbid anxiety disorder was obsessive compulsive disorder (20%), the second common comorbidity was social phobia (12.9%) and third common was generalized anxiety disorder (8.6%). The SF-36 subscales mental health, general health, vitality and role-physical points were higher in patients who didn’t have current anxiety disorder comorbidity. Conclusions: Our study shows that anxiety disorder comorbidity is associated with lower quality of life and higher number of previous depressive episodes. These results show the necessity of assessing the current and lifetime anxiety disorder comorbidity and its effects on the outcome of the disease in bipolar patients in every phase of the illness.

Keywords

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İki Uçlu Mizaç Bozukluğu Hastalarında Anksiyete Bozukluğu Ekhastalığı ve Yaşam Kalitesi

Öz

Amaç: İki Uçlu Mizaç Bozukluğu’nda (İUMB) eşlik eden hastalıkları değerlendiren çalışmaların çoğu, anksiyete bozukluğu (AB) ekhastalığının tanı, tedavi ve hastalık sürecini büyük oranda etkilediğini göstermektedir. Bu çalışmanın amacı, kliniğimize başvuran İUMB hastalarında AB yaygınlığını belirleyerek, ekhastalığın hastaların klinik özellikleri ve yaşam kalitesi bakımından karşılaştırmaktır. Yöntem: Çalışmaya 2010 yılı 0cak ve Mayıs ayları arasında, Şişli Etfal Eğitim ve Araştırma Hastanesi Psikiyatri kliniğinde ayakta ya da yatırılarak değerlendirilen DSM-IV tanı ölçütlerine göre İUMB I ve ya İUMB II tanısı alan 18-65 yaş arasında 70 hasta dahil edildi. Hastalara sosyodemografik veri formu, DSM-IV eksen tanıları için yapılandırılmış klinik görüşme ölçeği (SCID-I), Hamilton Depresyon Değerlendirme Ölçeği (Ham-D), Young Mani Değerledirme Ölçeği (YMDÖ), Yaşam Kalitesi Ölçeği Kısa Form (SF-36) ve AB ekhastalığı olan olgulara Hamilton Anksiyete Değerlendirme Ölçeği (Ham-A) uygulandı. Bulgular: İUMB olgularının %32.9’u değerlendirildiği dönemde AB tanısını almaktaydı. En sık görülen AB ekhastalığı obsesif kompulsif bozukluk (%20), sosyal anksiyete bozukluğu (%12.9) ve yaygın anksiyete bozukluğu. Genel sağlık, ruh sağlığı, rol güçlüğü fiziksel ve vitalite bölümlerinin ortalama puanları şimdiki dönem AB ekhastalığı olanlarda olmayanlara göre daha düşüktü. Sonuçlar: Çalışmamız AB’nin eşlik ettiği İUMB hastalarının yaşam kalitesinin, etmeyenlere göre daha olumsuz olarak etkilendiğini ve depresif geçirilen dönemlerin arttığını göstermiştir. Bu bağlamda şimdiki ve yaşam boyu anksiyete bozukluğunun İUMB’nin her evresinde sorgulanması, tedavi ve hastalığın seyri açısından önem kazanmaktadır.

Anahtar Kelimeler

• İki uçlu mizaç bozukluğu, anksiyete bozukluğu, ekhastalık

References

1. Angst J. The emerging epidemiology of hypomania and bipolar II disorder. J Affect Disord. 1998;50:143-151.
2. Ayuso-Mateos JL, Vázquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard OS, Casey P, Wilkinson C, Lasa L, Page H, Dunn G, Wilkinson G; ODIN Group. Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatry. 2001;179:308-316.
3. Kessler RC, Rubinow DR, Holmes C, Abelson JM, Zhao S. The epidemiology of DSM-III-R bipolar I disorder in a general population survey. Psychol Med. 1997;27:1079-89.
4. Lépine JP, Gastpar M, Mendlewicz J, Tylee A. Depression in the community: the first pan-European study DEPRES (Depression Research in European Society). Int Clin Psychopharmacol. 1997;12:19-29.
5. Regier DA, Boyd JH, Burke JD Jr, Rae DS, Myers JK, Kramer M, Robins LN, George LK, Karno M, Locke BZ. One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Arch Gen Psychiatry. 1988;45:977-986.
6. Szádóczky E, Papp Z, Vitrai J, Ríhmer Z, Füredi J. The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey. J Affect Disord. 1998;50:153-162.
7. Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lépine JP, Newman SC, Rubio-Stipec M, Wells JE, Wickramaratne PJ, Wittchen H, Yeh EK. Cross-national epidemiology of major depression and bipolar disorder. JAMA. 1996;276:293-299.
8. Henry C, Van den Bulke D, Bellivier F, Etain B, Rouillon F, Leboyer M. Anxiety disorders in 318 bipolar patients: prevalence and impact on illness severity and response to mood stabilizer. J Clin Psychiatry. 2003;64:331-335.

9. 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.
10. 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.
11. Boylan KR, Bieling PJ, Marriott M, Begin H, Young LT, MacQueen GM. Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar disorder. J Clin Psychiatry. 2004;65:1106- 1113.
12. Issler CK, Sant’anna MK, Kapczinski F, Lafer B. Anxiety disorders comorbidity in bipolar disorder. Rev Bras Psiquiatr. 2004;26:31-36.
13. Tamam L, Ozpoyraz N. Comorbidity of anxiety disorder among patients with bipolar I disorder in remission. Psychopathology. 2002;35:203-209.
14. Bauer MS, Altshuler L, Evans DR, Beresford T, Williford WO, Hauger R; VA Cooperative Study #430 Team. 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.
15. Keller MB. Prevalance and impact of comorbid anxiety and bipolar disorder. J Clin Psychiatry. 2006;67:5-7.
16. Zutshi A, Reddy YC, Thennarasu K, Chandrashekhar CR. Comorbidity of anxiety disorders in patients with remitted bipolar disorder. Eur Arch Psychiatry Clin Neurosci. 2006;256:428-436.
17. Otto MW, Simon NM, Wisniewski SR, Miklowitz DJ, Kogan JN, Reilly-Harrington NA, Frank E, Nierenberg AA, Marangell LB, Sagduyu K, Weiss RD, Miyahara S, Thas ME, Sachs GS, Pollack MH; STEP-BD Investigators. Prospective 12 month course of bipolar disorder in out-patients with and without comorbid anxiety disorders. Br J Psychiatry. 2006;189:20-25.
18. Sajatovic M, Kales HC. Diagnosis and management of bipolar disorder with comorbid anxiety in the elderly. J Clin Psychiatry. 2006;67:21-27.
19. Simon NM, Pollack MH, Ostacher MJ, Zalta AK, Chow CW, Fischmann D, Demopulos CM, Nierenberg AA, Otto MW. Understanding the link between anxiety symptoms and suicidal ideation and behaviors in outpatients with bipolar disorder. J Affect Disord. 2007;97:91-99.
20. 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.
21. 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;161:2222-29.
22. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinical Version. Washington: American Psyciatric Press, 1997.
23. Çorapçıoğlu A, Aydemir O, Yıldız M, Danacı AE, Köroğlu E. DSM- IV Eksen-I Bozuklukları İçin Yapılandırılmış Klinik Görüşme. Hekimler Yayın Birliği, 1999.
24. Williams BW. A structured interview guide for Hamilton Depression Rating Scale. Arch Gen Psychiatry. 1978;45:742-747.
25. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.
26. Akdemir A, Orsel S, Dağ İ ve ark. Hamilton Depresyon Derecelendirme Ölçeği’nin geçerliği, güvenilirliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi. 1996;4:251- 259.
27. Hamilton M. The Assesment of anxiety states by rating. Br J Med Psychol. 1959;32:50-55.
28. Yazıcı MK, Demir B, Tanrıverdi N, Karaağaoğlu E, Yolaç P. Hamilton Anksiyete Değerlendirme Ölçeği, değerlendiriciler arası güvenilirlik ve geçerlilik çalışması. Türk Psikiyatri Dergisi. 1998;9:114-117.
29. Karadağ F, Oral ET, Aran Yalçın F, Erten E. Young Mani Derecelendirme Ölçeğinin geçerlilik güvenilirlik çalışması. Türk Psikiyatri Dergisi. 2002;13(2):107-114.
30. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473-483.
31. Koçyiğit H, Aydemir Ö, Ölmez N, Memiş A. Kısa Form-36 Türkçe Versiyonun Güvenilirliği ve Geçerliliği. İlaç ve Tedavi Dergisi. 1999;12:102-106.
32. Albert U, Rosso G, Maina G, Bogetto F. Impact of anxiety disorder comorbidity on quality of life in euthymic bipolar disorder patients: differences between bipolar I and II subtypes. J Affect Disord. 2008;105:297-303.
33. Taylor CT, Hirshfeld-Becker DR, Ostacher MJ, Chow CW, LeBeau RT, Pollack MH, Nierenberg AA, Simon NM. Anxiety is associated with impulsivity in bipolar disorder. J Anxiety Disord. 2008;22:868- 876.
34. Lee JH, Dunner DL. The effect of anxiety disorder comorbidity on treatment resistant bipolar disorders. Depress Anxiety. 2008;25:91- 7.
35. Altindag A, Yanik M, Nebioglu M. The comorbidity of anxiety disorders in bipolar I patients: prevalence and clinical correlates. Isr J Psychiatry Relat Sci. 2006;43:10-15.
36. Azorin JM, Kaladjian A, Adida M, Hantouche EG, Hameg A, Lancrenon S, Akiskal HS. Psychopathological correlates of lifetime anxiety comorbidity in bipolar I patients: findings from a French national cohort. Psychopathology. 2009;42:380-86.
37. Gaudiano BA, Miller IW. Anxiety disorder comorbidity in bipolar I disorder: relationship to depression severity and treatment outcome. Depress Anxiety. 2005;21:71-77.
38. MacQueen GM, Marriott M, Begin H, Robb J, Joffe RT, Young LT. Subsyndromal symptoms assessed in longitudinal, prospective follow-up in a cohort of patients with bipolar disorder. Bipolar Disord. 2003;5:349-355.
39. Nakagawa A, Grunebaum MF, Sullivan GM, Currier D, Ellis SP, Burke AK, Brent DA, Mann JJ, Oquendo MA. Comorbid anxiety in bipolar disorder: does it have an independent effect on suicidality? Bipolar Disord. 2008;10:530–538.
40. Vieta E, Colom F, Corbella B, Martínez-Arán A, Reinares M, Benabarre A, Gastó C. Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disord. 2001;3:253-258.
41. Kauer-Sant’Anna M, Frey BN, Andreazza AC, Ceresér KM, Gazalle FK, Tramontina J, da Costa SC, Santin A, Kapczinski F. Anxiety comorbidity and quality of life in bipolar disorder patients. Can J Psychiatry. 2007;52:175-181.
42. Simon NM, Zalta AK, Otto MW, Ostacher MJ, Fischmann D, Chow CW, Thompson EH, Stevens JC, Demopulos CM, Nierenberg AA, Pollack MH. The association of comorbid anxiety disorders with suicide attempts and suicidal ideation in outpatients with bipolar disorder. J Psychiatr Res. 2007;41:255-264.