Bipolar remission influenced by anxiety and OCD

By Laura Cowen, medwireNews Reporter

Anxiety disorders and obsessive compulsive disorder (OCD) may reduce the likelihood of achieving remission for patients with bipolar disorder, study findings indicate.

Generally, comorbid disorders were more likely to prevent remission in the first, rather than second, year of follow-up and had a greater impact on recovery from depressive rather than manic symptoms, report Michael Berk (Deakin University, Geelong, Victoria, Australia) and colleagues.

Of the 174 patients with bipolar I disorder (mean age 43 years, 61% women), 73 (42%) had at least one comorbid anxiety disorder (panic disorder, agoraphobia, social anxiety disorder or generalised anxiety disorder) and/or OCD at baseline.

Patients with any of these disorders had a significantly lower remission rate during 2 years of follow-up than those with no comorbid anxiety disorders or OCD. Remission was defined as both a Young Mania Rating Scale (YMRS) total score of 12 or lower and a 21-item Hamilton Depression Rating Scale (HAMD-21) total score of 8 or lower.

When the researchers analysed the data for the first and second years of follow-up separately, they found that all comorbid disorders were associated with significantly lower remission rates in the first year, whereas only generalised anxiety disorder and OCD were linked to lower rates in the second year.

All of the anxiety disorders and OCD were also associated with lower remission from depression (HAMD-21 scores), whereas only OCD was linked to lower remission from mania (YMRS scores).

Furthermore, patients with OCD, as well as those with generalised anxiety disorder, showed a poorer response to therapy with an atypical antipsychotic than those without such comorbidities. By contrast, the response to conventional mood stabilisers was negatively affected by all of the comorbidities studied.

“The impact of OCD on poor outcome, regardless of evaluation time, type of medication, and mood symptoms, suggests that OCD is a particularly important comorbid condition in patients with bipolar disorder”, write Berk and co-authors in the Journal of Affective Disorders.

They conclude: “Given the clinical significance of comorbid anxiety disorders and OCD in bipolar disorder, routine and regular evaluations of comorbid anxiety disorders and OCD using a formal diagnostic interview are recommended.

“Furthermore, special attention and management strategies are required for patients with these comorbid disorders to achieve better treatment outcomes in bipolar disorders.”

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