title: Social anxiety disorder comorbidity in patients with bipolar disorder: a clinical replication.
abstract: BACKGROUND
  The authors investigated frequency, clinical correlates and onset temporal relationship of social anxiety disorder (SAD) in adult patients with a diagnosis of bipolar I disorder.
  
  
  METHODS
  Subjects were 189 patients whose diagnoses were assessed by the Structured Clinical Interview for DSM-III-R-Patient Version.
  
  
  RESULTS
  Twenty-four patients (12.7%) met DSM-III-R criteria for lifetime SAD; of these, 19 (10.1% of entire sample) had SAD within the last month. Significantly more bipolar patients with comorbid SAD also had substance use disorders compared to those without. On the HSCL-90, levels of interpersonal sensitivity, obsessiveness, phobic anxiety and paranoid ideation were significantly higher in bipolar patients with SAD than in those without. Bipolar patients with comorbid SAD recalled separation anxiety problems (school refusal) more frequently during childhood than those without. Lifetime SAD comorbidity was associated with an earlier age at onset of syndromal bipolar disorder. Pre-existing OCD tended to delay the onset of bipolarity.
  
  
  CONCLUSIONS
  Social anxiety disorder comorbidity is not rare among patients with bipolar disorder and is likely to affect age of onset and phenomenology of bipolar disorder. These findings may influence treatment planning and the possibility of discovering a pathophysiological relationship between SAD and bipolarity.
authors.affiliation: Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, via Roma 65, I-56100 Pisa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pini
authors.forename: Jack D
authors.initials: JD
authors.lastname: Maser
authors.forename: Liliana
authors.initials: L
authors.lastname: Dell'Osso
authors.forename: Marianna
authors.initials: M
authors.lastname: Abelli
authors.forename: Matteo
authors.initials: M
authors.lastname: Muti
authors.forename: Camilla
authors.initials: C
authors.lastname: Gesi
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Cassano
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires