Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA.
J Affect Disord. 2019 Mar 1;246:126-131. doi: 10.1016/j.jad.2018.12.039. Epub 2018 Dec 18.
Approximately 86-89% of patients with BD have a comorbid anxiety disorder associated with poor quality of life and reduced likelihood of recovery from an acute mood episode. The purpose of this study is to assess the prevalence and impact of comorbid anxiety using the Bipolar Inventory of Symptoms Scale (BISS) in patients with BD who participated in a 6-month pragmatic trial.
Participants (N = 482) in the Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (CHOICE) study were adults with BD I or II. Anxiety diagnoses were assessed with the MINI. Global illness severity was assessed using the Clinical Global Impression-Bipolar Version. Mood symptoms and anxiety severity were assessed using the BISS.
61% of the study sample met criteria for a current anxiety disorder. Patients with a higher BISS anxiety score at baseline had a higher overall BD illness severity, depressive severity, and manic episode severity (p < 0.001). A single cutoff value of BISS anxiety had great sensitivity, yet poor specificity for determining a comorbid anxiety diagnosis. There were no significant differences in outcomes for individuals treated for anxiety disorders with anxiolytics compared with those who were not treated with anxiolytics.
Sample size limitations prevented an analysis of whether the BISS cutoff score of 10 performed differently across varied anxiety disorders.
Given its ability to identify patients with co-occurring anxiety, the BISS anxiety subscale shows clinical utility as a screening measure though its application as a clinical assessment measure may not be advisable.
大约 86-89%的双相情感障碍（BD）患者存在与生活质量差和急性情绪发作后恢复可能性降低相关的共病焦虑症。本研究的目的是使用双相情感障碍症状量表（BISS）评估在参加为期 6 个月实用临床试验的 BD 患者中，共病焦虑症的患病率和影响。
双相情感障碍临床健康结果比较有效性（CHOICE）研究中的参与者（N=482）为 BD I 或 II 型的成年人。使用 MINI 评估焦虑症诊断。使用临床总体印象-双相版本评估总体疾病严重程度。使用 BISS 评估情绪症状和焦虑严重程度。
研究样本中有 61%符合当前焦虑症的标准。基线时 BISS 焦虑评分较高的患者具有更高的整体 BD 疾病严重程度、抑郁严重程度和躁狂发作严重程度（p<0.001）。BISS 焦虑的单一截断值具有很好的敏感性，但对于确定共病焦虑症诊断的特异性较差。对于接受抗焦虑药物治疗的焦虑症患者与未接受抗焦虑药物治疗的患者，其治疗结果无显著差异。
样本量限制使得无法分析 BISS 截断值 10 在不同焦虑障碍中的表现是否不同。
鉴于其识别共病焦虑症患者的能力，BISS 焦虑子量表作为一种筛查工具具有临床实用性，但作为临床评估工具的应用可能并不合适。
