title: Effects of comorbid anxiety disorders on the longitudinal course of pediatric bipolar disorders.
abstract: OBJECTIVE
  To examine the longitudinal effects of comorbid anxiety disorders in youth with bipolar spectrum disorder (BP).
  
  
  METHODS
  As part of the Course and Outcome of Bipolar Youth study, 413 youth, who were 7 through 17 years or age and who met criteria for DSM-IV BP-I (n = 244), BP-II (n = 28), and operationally defined bipolar disorder not otherwise specified (BP-NOS) (n = 141) were included. Subjects were followed on average 5 years using the Longitudinal Interval Follow-up Evaluation. Effects of anxiety on the time to mood recovery and recurrence and percentage of time with syndromal and subsyndromal mood symptomatology during the follow-up period were analyzed.
  
  
  RESULTS
  At intake and during the follow-up, 62% of youth with BP met criteria for at least 1 anxiety disorder. About 50% of the BP youth with anxiety had ≥2 anxiety disorders. Compared to BP youth without anxiety, those with anxiety had significantly more depressive recurrences and significantly longer median time to recovery. The effects of anxiety on recovery disappeared when the severity of depression at intake was taken into account. After adjusting for confounding factors, BP youth with anxiety, particularly those with ≥2 anxiety disorders, spent significantly less follow-up time asymptomatic and more time with syndromal mixed/cycling and subsyndromal depressive symptomatology compared to those without anxiety.
  
  
  CONCLUSIONS
  Anxiety disorders are common and adversely affect the course of BP in youth, as characterized by more mood recurrences, longer time to recovery, less time euthymic, and more time in mixed/cycling and depressive episodes. Prompt recognition and the development of treatments for BP youth with anxiety are warranted.
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine; Institute of Psychiatry, King's College London. Electronic address: regina.sala_cassola@kcl.ac.uk.
authors.forename: Regina
authors.initials: R
authors.lastname: Sala
authors.affiliation: David Geffen School of Medicine, University of California at Los Angeles.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Strober
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: David A
authors.initials: DA
authors.lastname: Axelson
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Gill
authors.affiliation: IDIBAPS, CIBERSAM, Neurosciences Institute, Hospital Clinic de Barcelona, Universitat de Barcelona.
authors.forename: Josefina
authors.initials: J
authors.lastname: Castro-Fornieles
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Tina R
authors.initials: TR
authors.lastname: Goldstein
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Goldstein
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Wonho
authors.initials: W
authors.lastname: Ha
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Fangzi
authors.initials: F
authors.lastname: Liao
authors.affiliation: University of Pittsburgh.
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.affiliation: Butler Hospital, Brown University School of Medicine.
authors.forename: Shirley
authors.initials: S
authors.lastname: Yen
authors.affiliation: Butler Hospital, Brown University School of Medicine.
authors.forename: Heather
authors.initials: H
authors.lastname: Hower
authors.affiliation: Butler Hospital, Brown University School of Medicine.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hunt
authors.affiliation: Butler Hospital, Brown University School of Medicine.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Dickstein
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Neal D
authors.initials: ND
authors.lastname: Ryan
authors.affiliation: Butler Hospital, Brown University School of Medicine.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male
keywords: anxiety disorders; bipolar disorders; longitudinal study