Zutshi A, Reddy Y C Janardhan, Thennarasu K, Chandrashekhar C R
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
Eur Arch Psychiatry Clin Neurosci. 2006 Oct;256(7):428-36. doi: 10.1007/s00406-006-0658-2. Epub 2006 Jun 16.
Comorbidity between bipolar disorder and anxiety disorders has attracted considerable attention in recent years. However, a majority of the earlier studies examined anxiety disorders in acutely ill patients resulting in a possible confounding effect of the affective episodes. This study examines the prevalence of anxiety disorders in remitted bipolar subjects recruited from a psychiatric hospital in India and their effect on the severity of bipolar illness. A total of eighty remitted DSM-IV adult bipolar subjects and 50 non-psychiatric controls were recruited over a 10-month period. They were evaluated using a structured interview and various scales. The effect of anxiety disorders on bipolar severity was analyzed using multiple regression analyses. Anxiety disorders were highly prevalent in bipolar subjects compared to controls (49 [61%] vs. 7 [14%], chi(2) = 28.01, P < 0.001). Commonest lifetime anxiety disorder was obsessive-compulsive disorder (35%). Lifetime anxiety disorder had significant effect on all four indices of severity of illness, that included (1) percentage of time spent in episodes (Beta = 18.67, SE = 5.11, P < 0.001), (2) maximum period of continuous euthymia in the preceding 2 years (Beta = -5.26, SE = 1.71, P = 0.003), (3) presence of psychosis (Beta = 3.22, SE = 1.02, P = 0.002), and 4) response to mood stabilizers (Beta = -2.11, SE = 0.76, P = 0.006). The findings of this study confirm previous observations of the high prevalence and negative impact of comorbid anxiety disorders in bipolar disorder and also demonstrate that the findings are similar in culturally diverse settings. Future studies should systematically examine the various treatment options for anxiety disorders in bipolar patients. It is also necessary to examine the neurobiological and family/genetic correlates of anxious bipolar subjects to validate if they are a subgroup of bipolar disorders.
近年来，双相情感障碍与焦虑症之间的共病现象备受关注。然而，大多数早期研究考察的是急性病患者的焦虑症，这可能导致情感发作产生混淆效应。本研究调查了从印度一家精神病院招募的缓解期双相情感障碍患者中焦虑症的患病率及其对双相情感障碍严重程度的影响。在10个月的时间里，共招募了80名缓解期的DSM-IV成年双相情感障碍患者和50名非精神科对照者。使用结构化访谈和各种量表对他们进行评估。采用多元回归分析焦虑症对双相情感障碍严重程度的影响。与对照组相比，双相情感障碍患者中焦虑症的患病率很高（49例[61%]对7例[14%]，χ² = 28.01，P < 0.001）。最常见的终生焦虑症是强迫症（35%）。终生焦虑症对疾病严重程度的所有四个指标均有显著影响，包括：（1）发作期所花费的时间百分比（β = 18.67，标准误 = 5.11，P < 0.001），（2）前两年连续心境正常的最长时间（β = -5.26，标准误 = 1.71，P = 0.003），（3）精神病的存在（β = 3.22，标准误 = 1.02，P = 0.002），以及（4）对心境稳定剂的反应（β = -2.11，标准误 = 0.76，P = 0.006）。本研究结果证实了先前关于双相情感障碍中共病焦虑症的高患病率和负面影响的观察结果，同时也表明在不同文化背景下结果相似。未来的研究应系统地考察双相情感障碍患者焦虑症的各种治疗选择。还需要研究焦虑型双相情感障碍患者的神经生物学以及家庭/遗传相关性，以验证他们是否是双相情感障碍的一个亚组。
