title: Clinical significance of lifetime panic disorder in the course of bipolar disorder type I.
abstract: OBJECTIVE
  The aim of the study was to analyze the impact of lifetime panic disorder (PD) diagnosis in a sample of patients with bipolar disorder type I (BPI), evaluating clinical and demographic variables.
  
  
  METHODS
  Ninety-five outpatients from the Bipolar Disorder Research Program at the Institute of Psychiatry of the University of Sao Paulo Medical School were enrolled. Twenty-seven BPI patients with PD were compared to 68 BPI patients without any anxiety disorders regarding clinical and demographic variables.
  
  
  RESULTS
  Compared to BPI patients without any anxiety disorders, patients with BPI + PD presented significantly higher number of mood episodes (18.9 +/- 13.8 vs 8.5 +/- 7.8; P < .001), depressive episodes (10.8 +/- 8.2 vs 4.6 +/- 4.8; P = .001), and manic episodes (7.4 +/- 7.3 vs 3.6 +/- 3.6; P = .008). Patients with BPI + PD had more frequently a depressive episode as their first one compared to BPI patients without anxiety disorders (94.1% vs 57.5%; P = .011). Patients with BPI + PD had more comorbidity with lifetime diagnosis of drug abuse or dependence (33.3% vs 8.8%; P = .010) and eating disorders (29.6% vs 6.0%; P = .004).
  
  
  CONCLUSIONS
  The higher number of mood episodes in general presented by patients with BPI + PD when compared with BPI patients without any anxiety disorders, along with the higher frequencies of drug misuse and eating disorders, indicates that PD comorbidity is associated with a poorer course and outcome of BPI. The higher frequency of depression as the onset mood episode and the higher number of manic episodes in the group with PD may have important treatment implications and should be further investigated.
authors.affiliation: Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil. ricardo.toniolo@uol.com.br
authors.forename: Ricardo Alexandre
authors.initials: RA
authors.lastname: Toniolo
authors.forename: Sheila C
authors.initials: SC
authors.lastname: Caetano
authors.forename: Patrícia Viana
authors.initials: PV
authors.lastname: da Silva
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
mesh_terms: D000328:Adult; D017668:Age of Onset; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D003710:Demography; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D012720:Severity of Illness Index; D013997:Time Factors