title: Impact of comorbid anxiety disorders and obsessive-compulsive disorder on 24-month clinical outcomes of bipolar I disorder.
abstract: BACKGROUND
  This study investigated the impact of comorbid obsessive-compulsive disorder (OCD) and four anxiety disorders [panic disorder (PD), agoraphobia, social anxiety disorder (SAD), and generalized anxiety disorder (GAD)] on the clinical outcomes of bipolar disorder.
  
  
  METHODS
  This study analysed data of 174 patients with bipolar I disorder who participated in the prospective observational study. Participants were assessed every 3 months for 24 months. The primary outcome measure was the achievement of symptomatic remission, defined by a total score on the Young Mania Rating Scale (YMRS) of ≤12 and a total score on the 21-item Hamilton Depression Rating Scale (HAMD-21) of ≤8.
  
  
  RESULTS
  Comorbidity was associated with decreased likelihood of remission. However, the impact of individual disorders on outcome differed according to clinical and treatment situations. Most comorbid anxiety disorders and OCD had a negative effect on remission during the first year of evaluation, as measured by the HAMD-21, and in patients taking a conventional mood stabilizer alone. However, the association with poorer outcome was observed only for a few specific comorbid disorders in the second year (GAD and OCD), as measured by YMRS-defined remission (OCD), and in patients with olanzapine therapy (GAD and OCD).
  
  
  CONCLUSIONS
  Follow-up evaluation of comorbid disorders was lacking.
  
  
  CONCLUSIONS
  Comorbid anxiety disorders and OCD negatively influenced the clinical course of bipolar disorder. Specifically, OCD had a consistently negative impact on the outcome of bipolar I disorder regardless of clinical situation. Effective strategies for the control of these comorbidities are required to achieve better treatment outcomes.
authors.affiliation: Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea.
authors.forename: Sung-Wan
authors.initials: SW
authors.lastname: Kim
authors.affiliation: IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong 3220, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia.
authors.forename: Lesley
authors.initials: L
authors.lastname: Berk
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, School of Psychology and Psychiatry, Commercial Road, Melbourne 3004, VIC, Australia.
authors.forename: Jayashri
authors.initials: J
authors.lastname: Kulkarni
authors.affiliation: IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong 3220, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia.
authors.forename: Seetal
authors.initials: S
authors.lastname: Dodd
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, School of Psychology and Psychiatry, Commercial Road, Melbourne 3004, VIC, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: de Castella
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, School of Psychology and Psychiatry, Commercial Road, Melbourne 3004, VIC, Australia.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Fitzgerald
authors.affiliation: Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia; Orygen Youth Health Research Centre, Parkville 3052, VIC, Australia.
authors.forename: G Paul
authors.initials: GP
authors.lastname: Amminger
authors.affiliation: IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong 3220, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia; Orygen Youth Health Research Centre, Parkville 3052, VIC, Australia; Florey Institute for Neuroscience and Mental Health, Parkville 3052, VIC, Australia. Electronic address: MIKEBE@BarwonHealth.org.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology*; D016584:Panic Disorder / Q000453:epidemiology; D010698:Phobic Disorders / Q000453:epidemiology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents
keywords: Anxiety disorder; Bipolar disorder; Comorbidity; Observational study; Obsessive–compulsive disorder; Remission