Goes Fernando S
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Meyer 4-119A, 600 North Wolfe Street, Baltimore, MD, 21287, USA,
Curr Psychiatry Rep. 2015 Feb;17(2):3. doi: 10.1007/s11920-014-0540-2.
Anxiety symptoms and syndromes are common in bipolar disorders, occurring in over half of all subjects with bipolar disorder type I. Despite methodological and diagnostic inconsistencies, most studies have shown a robust association between the presence of a broadly defined comorbid anxiety disorder and important indices of clinical morbidity in bipolar disorder, including a greater number of depressive episodes, worse treatment outcomes, and elevated risk of attempting suicide. Anxiety symptoms and/or syndromes often precede the onset of bipolar disorder and may represent a clinical phenotype of increased risk in subjects with prodromal symptoms. Although the causal relationship between anxiety and bipolar disorders remains unresolved, the multifactorial nature of most psychiatric phenotypes suggests that even with progress towards more biologically valid phenotypes, the "phenomenon" of comorbidity is likely to remain a clinical reality. Treatment studies of bipolar patients with comorbid anxiety have begun to provide preliminary evidence for the role of specific pharmacological and psychotherapeutic treatments, but these need to be confirmed in more definitive trials. Hence, there is an immediate need for further research to help guide assessment and help identify appropriate treatments for comorbid conditions.
焦虑症状和综合征在双相情感障碍中很常见，超过半数的I型双相情感障碍患者会出现。尽管在方法学和诊断方面存在不一致，但大多数研究表明，广义定义的共病焦虑障碍的存在与双相情感障碍的重要临床发病指标之间存在密切关联，包括更多的抑郁发作、更差的治疗效果以及更高的自杀未遂风险。焦虑症状和/或综合征通常在双相情感障碍发作之前出现，可能代表前驱症状患者中风险增加的一种临床表型。尽管焦虑与双相情感障碍之间的因果关系尚未解决，但大多数精神疾病表型的多因素性质表明，即使在朝着更具生物学有效性的表型发展方面取得进展，共病“现象”可能仍然是一个临床现实。对伴有共病焦虑的双相情感障碍患者的治疗研究已开始为特定药物和心理治疗的作用提供初步证据，但这些需要在更明确的试验中得到证实。因此，迫切需要进一步研究，以帮助指导评估并确定共病情况的适当治疗方法。
