Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder.

OBJECTIVE Bipolar disorder often co-occurs with other axis I disorders, but little is known about the relationships between the clinical features of bipolar illness and these comorbid conditions. Therefore, the authors assessed comorbid lifetime and current axis I disorders in 288 patients with bipolar disorder and the relationships of these comorbid disorders to selected demographic and historical illness variables. METHOD They evaluated 288 outpatients with bipolar I or II disorder, using structured diagnostic interviews and clinician-administered and self-rated questionnaires to determine the diagnosis of bipolar disorder, comorbid axis I disorder diagnoses, and demographic and historical illness characteristics. RESULTS One hundred eighty-seven (65%) of the patients with bipolar disorder also met DSM-IV criteria for at least one comorbid lifetime axis I disorder. More patients had comorbid anxiety disorders (N=78, 42%) and substance use disorders (N=78, 42%) than had eating disorders (N=9, 5%). There were no differences in comorbidity between patients with bipolar I and bipolar II disorder. Both lifetime axis I comorbidity and current axis I comorbidity were associated with earlier age at onset of affective symptoms and syndromal bipolar disorder. Current axis I comorbidity was associated with a history of development of both cycle acceleration and more severe episodes over time. CONCLUSIONS Patients with bipolar disorder often have comorbid anxiety, substance use, and, to a lesser extent, eating disorders. Moreover, axis I comorbidity, especially current comorbidity, may be associated with an earlier age at onset and worsening course of bipolar illness. Further research into the prognostic and treatment response implications of axis I comorbidity in bipolar disorder is important and is in progress.

[1]  J BERKSON,et al.  Limitations of the application of fourfold table analysis to hospital data. , 1946, Biometrics.

[2]  G. Winokur The Iowa 500: heterogeneity and course in manic-depressive illness (bipolar). , 1975, Comprehensive psychiatry.

[3]  R. Hirschfeld,et al.  NIMH clinical research branch collaborative program on the psychobiology of depression. , 1979, Archives of general psychiatry.

[4]  L. George,et al.  Exclusion criteria of DSM-III. A study of co-occurrence of hierarchy-free syndromes. , 1984, Archives of general psychiatry.

[5]  Himmelhoch Jm,et al.  Sources of lithium resistance in mixed mania. , 1986 .

[6]  Dilsaver Sc The pathophysiologies of substance abuse and affective disorders: an integrative model? , 1987 .

[7]  H G Pope,et al.  A controlled study of lifetime prevalence of affective and other psychiatric disorders in bulimic outpatients. , 1987, The American journal of psychiatry.

[8]  T. R. Pryzbeck,et al.  The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. , 1988, Journal of studies on alcohol.

[9]  D. Black,et al.  Complicated mania. Comorbidity and immediate outcome in the treatment of mania. , 1988, Archives of general psychiatry.

[10]  D. Black,et al.  Predictors of immediate response in the treatment of mania: The importance of comorbidity , 1988, Biological Psychiatry.

[11]  D. Black,et al.  The effect of somatic treatment and comorbidity on immediate outcome in manic patients. , 1989, Comprehensive psychiatry.

[12]  C. Waternaux,et al.  Four-year follow-up of twenty-four first-episode manic patients. , 1990, Journal of affective disorders.

[13]  H. Pope,et al.  Affective spectrum disorder: does antidepressant response identify a family of disorders with a common pathophysiology? , 1990, The American journal of psychiatry.

[14]  D S Rae,et al.  Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. , 1990, JAMA.

[15]  K. Halmi,et al.  Comorbidity of psychiatric diagnoses in anorexia nervosa. , 1991, Archives of general psychiatry.

[16]  B. Cuthbertson,et al.  Outcome of Bipolar Disorder on Long-Term Treatment with Lithium , 1991, British Journal of Psychiatry.

[17]  K. Brady,et al.  Bipolar Affective Disorder and Substance Abuse , 1992, Journal of clinical psychopharmacology.

[18]  A. Stoll,et al.  Comorbidity in mania at first hospitalization. , 1992, The American journal of psychiatry.

[19]  S. Simpson,et al.  Bipolar II Affective Disorder in Eating Disorder Inpatients , 1992, The Journal of nervous and mental disease.

[20]  H. Akiskal,et al.  Affective comorbidity in panic disorder: is there a bipolar connection? , 1993, Journal of affective disorders.

[21]  R. Joffe,et al.  Anxious and non-anxious bipolar disorder. , 1993, Journal of affective disorders.

[22]  A. Stoll,et al.  Comorbidity in psychosis at first hospitalization. , 1993, The American journal of psychiatry.

[23]  R. Hirschfeld,et al.  The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. , 1994, Journal of affective disorders.

[24]  K. Brady,et al.  Substance Abuse and Bipolar Affective Disorder , 1994, The Journal of nervous and mental disease.

[25]  R. Kessler,et al.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. , 1994, Archives of general psychiatry.

[26]  S. Strakowski,et al.  The Co-Occurrence of Mania with Medical and other Psychiatric Disorders , 1994, International journal of psychiatry in medicine.

[27]  R. Bowen,et al.  Mood Swings in Patients with Panic Disorder , 1994, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[28]  S. Dilsaver,et al.  Comorbidity of panic disorder in bipolar illness: evidence from the Epidemiologic Catchment Area Survey. , 1995, The American journal of psychiatry.

[29]  S. Dilsaver,et al.  Comorbidity for obsessive-compulsive disorder in bipolar and unipolar disorders , 1995, Psychiatry Research.

[30]  S. Strakowski,et al.  Differences and similarities in mixed and pure mania. , 1995, Comprehensive psychiatry.

[31]  H. Akiskal,et al.  Alcoholism in manic-depressive (bipolar) illness: familial illness, course of illness, and the primary-secondary distinction. , 1995, The American journal of psychiatry.

[32]  E. Persad,et al.  Comorbidity of obsessive compulsive disorder in bipolar disorder. , 1995, Journal of affective disorders.

[33]  R. Kessler,et al.  The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. , 1996, The American journal of orthopsychiatry.

[34]  R. Cooke,et al.  Comorbidity of binge eating disorder and the partial binge eating syndrome with bipolar disorder. , 1996, The International journal of eating disorders.

[35]  R. Kessler,et al.  The epidemiology of DSM-III-R bipolar I disorder in a general population survey , 1997, Psychological Medicine.

[36]  S. Montgomery,et al.  Prevalence of anxiety disorders comorbidity in bipolar depression, unipolar depression and dysthymia. , 1997, Journal of affective disorders.

[37]  J. Füredi,et al.  The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey. , 1998, Journal of affective disorders.

[38]  A. Leon,et al.  A history of substance abuse complicates remission from acute mania in bipolar disorder. , 1999, The Journal of clinical psychiatry.

[39]  A J Rush,et al.  The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. , 2001, Journal of affective disorders.

[40]  A. Rush,et al.  The Stanley Foundation Bipolar Treatment Outcome Network. I. Longitudinal methodology. , 2001, Journal of affective disorders.