title: Co-morbid anxiety disorders in bipolar disorder and major depression: familial aggregation and clinical characteristics of co-morbid panic disorder, social phobia, specific phobia and obsessive-compulsive disorder.
abstract: BACKGROUND
  Co-morbidity of mood and anxiety disorders is common and often associated with greater illness severity. This study investigates clinical correlates and familiality of four anxiety disorders in a large sample of bipolar disorder (BP) and major depressive disorder (MDD) pedigrees.
  
  
  METHODS
  The sample comprised 566 BP families with 1416 affected subjects and 675 MDD families with 1726 affected subjects. Clinical characteristics and familiality of panic disorder, social phobia, specific phobia and obsessive-compulsive disorder (OCD) were examined in BP and MDD pedigrees with multivariate modeling using generalized estimating equations.
  
  
  RESULTS
  Co-morbidity between mood and anxiety disorders was associated with several markers of clinical severity, including earlier age of onset, greater number of depressive episodes and higher prevalence of attempted suicide, when compared with mood disorder without co-morbid anxiety. Familial aggregation was found with co-morbid panic and OCD in both BP and MDD pedigrees. Specific phobia showed familial aggregation in both MDD and BP families, although the findings in BP were just short of statistical significance after adjusting for other anxiety co-morbidities. We found no evidence for familiality of social phobia.
  
  
  CONCLUSIONS
  Our findings suggest that co-morbidity of MDD and BP with specific anxiety disorders (OCD, panic disorder and specific phobia) is at least partly due to familial factors, which may be of relevance to both phenotypic and genetic studies of co-morbidity.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. fgoes1@jhmi.edu
authors.forename: F S
authors.initials: FS
authors.lastname: Goes
authors.forename: M G
authors.initials: MG
authors.lastname: McCusker
authors.forename: O J
authors.initials: OJ
authors.lastname: Bienvenu
authors.forename: D F
authors.initials: DF
authors.lastname: Mackinnon
authors.forename: F M
authors.initials: FM
authors.lastname: Mondimore
authors.forename: B
authors.initials: B
authors.lastname: Schweizer
authors.forename: J R
authors.initials: JR
authors.lastname: Depaulo
authors.forename: J B
authors.initials: JB
authors.lastname: Potash
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000235:genetics; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000235:genetics; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D010375:Pedigree; D012720:Severity of Illness Index
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