Co-occurring Anxiety Disorders Research Articles

Drinking to cope with negative emotions moderates alcohol use disorder treatment response in patients with co-occurring anxiety disorder

BackgroundEpidemiological studies and theory implicate drinking to cope (DTC) with anxiety as a potent moderator of the association between anxiety disorder (AnxD) and problematic alcohol use. However, the relevance of DTC to the treatment of alcohol use disorder (AUD) in those with a co-occurring AnxD has not been well studied. To address this, we examined whether DTC moderates the impact of two therapies: (1) a cognitive behavioral therapy (CBT) designed to reduce DTC and anxiety symptoms; (2) a progressive muscle relaxation training (PMRT) program designed to reduce anxiety symptoms only. MethodsPatients undergoing a standard AUD residential treatment with a co-occurring AnxD (N=218) were randomly assigned to also receive either the CBT or PMRT. DTC in the 30 days prior to treatment was measured using the Unpleasant Emotions subscale of the Inventory of Drinking Situations. ResultsConfirming the predicted moderator model, the results indicated a significant interaction between treatment group and level of pre-treatment DTC behavior. Probing this interaction revealed that for those reporting more pre-treatment DTC behavior, 4-month alcohol outcomes were superior in the CBT group relative to the PMRT group. For those reporting less pre-treatment DTC behavior, however, 4-month alcohol outcomes were similar and relatively good in both treatment groups. ConclusionsThese findings establish a meaningful clinical distinction among those with co-occurring AUD-AnxD based on the degree to which the symptoms of the two disorders are functionally linked through DTC. Those whose co-occurring AUD-AnxD is more versus less strongly linked via DTC are especially likely to benefit from standard AUD treatment that is augmented by a brief CBT designed to disrupt this functional link.

Recognizing the Extent of Overlap Between Bipolar Disorder and Anxiety Disorders

The meta-analysis of prevalence of anxiety disorders among patients with bipolar disorder in this issue of E-Biomedicine (Nabavi et al., 2015) provides a timely summary of knowledge to date regarding this important co-occurrence of psychiatric conditions. The authors report that 43% of people with bipolar disorder have had at least one lifetime anxiety disorder. This figure is very similar to the 45% rate of people with bipolar disorder having had at least one lifetime anxiety disorder recently reported in a recent different meta-analysis, based on an only partially (less than half) overlapping set of studies (Pavlova et al., 2015). Individuals with bipolar disorder commonly have had more than one lifetime anxiety disorder. Indeed, the sum of the lifetime prevalences reported by Nabavi and associates for the individual anxiety disorders (panic disorder, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, specific phobia, obsessive compulsive disorder, and agoraphobia) was approximately twice as high (nearly 85%) as that for any anxiety disorder. Nabavi and associates' 43% meta-analytic lifetime prevalence rate of any anxiety disorder is slightly below the 48% mid-point between the lowest (17%) (Angst et al., 2013) and highest (79%) (Pini et al., 1997) lifetime prevalence rates reported in the individual studies reviewed, highlighting the substantial heterogeneity of anxiety disorder lifetime prevalence across samples. This important heterogeneity was evident despite only including studies that used the rigorous approach of using interview-based diagnosis for comorbid anxiety disorders. As such heterogeneity likely has meaningful relationships with not only neurobiology but also clinical outcomes, researchers and clinicians alike need to account for anxiety disorder comorbidity in their efforts to understand, diagnose, and treat patients with complicated bipolar disorders. The very substantial percentage of bipolar disorder patients with a lifetime anxiety disorder has particularly profound clinical implications. Anxiety disorders and alcohol/substance use disorders commonly co-occur with one another and with mood disorders. Indeed, anxiety disorders and alcohol/substance use disorders constitute the two most commonly encountered comorbid conditions in people with bipolar disorder (Merikangas et al., 2007). As the authors point out, management of comorbid anxiety disorders in bipolar disorder patients with antidepressants and benzodiazepines may be limited by the risks of mood destabilization and exacerbation of substance use problems, respectively. Moreover, the utility of other medications, such as second-generation antipsychotics may be limited by inefficacy and/or adverse effects, whereas the utility of adjunctive psychotherapy may be limited by inefficacy, particularly in individuals challenged by more than one anxiety disorder in addition to bipolar disorder (Deckersbach et al., 2014). Like many good studies, Nabavi and associates' article raises more questions than it answers. Prior studies have consistently reported associations in bipolar disorder patients between comorbid anxiety disorders and multiple unfavorable illness characteristics, including earlier bipolar disorder onset age, and increased suicidality, rate of substance use disorders, and mood episode severity and frequency, as well as treatment resistance. Teasing out how this multivariate “web of causality” of factors (that include comorbid anxiety disorders) mediates poorer outcomes could help inform prioritization of efforts to enhance prognosis in patients with bipolar disorder and comorbid anxiety disorders. In addition, Nabavi and associates' study (which focused on individuals with bipolar I disorder) did not address the important question of putative differential lifetime anxiety disorder comorbidity rates in people with bipolar I disorder compared to those with bipolar II disorder. Finally, Nabavi and associates' study did not address important questions regarding the degree to which co-occurring anxiety and bipolar disorders may be independent or inter-related problems. Although meta-analysis of the clinical correlates of anxiety disorder comorbidity in bipolar disorder patients was beyond the scope of this paper, and as pointed out by the authors, may have substantial feasibility limitations; such information could importantly inform clinical efforts to mitigate the adverse effects of concurrent anxiety disorders in patients with bipolar disorder. Information regarding the impact of interventions focusing on relieving comorbid anxiety upon overall mood and anxiety disorder illness burden in individuals remains an important research priority. Nevertheless, Nabavi and associates' study leaves both researchers and clinicians with a very clear take-home message – that the very common occurrence of anxiety disorders in people with bipolar disorder contributes in an important fashion to challenges faced by those striving to accurately assess neurobiology and diagnosis and to provide effective treatment for individuals struggling with both conditions.

Temporal dynamics of anxiety phenotypes in a dental pulp injury model.

BackgroundAccumulating clinical and preclinical evidence indicates that chronic pain is often comorbid with persistent low mood and anxiety. However, the mechanisms underlying pain-induced anxiety, such as its causality, temporal progression, and relevant neural networks are poorly understood, impeding the development of efficacious therapeutic approaches.ResultsHere, we have identified the sequential emergence of anxiety phenotypes in mice subjected to dental pulp injury (DPI), a prototypical model of orofacial pain that correlates with human toothache. Compared with sham controls, mice subjected to DPI by mechanically exposing the pulp to the oral environment exhibited significant signs of anxiogenic effects, specifically, altered behaviors on the elevated plus maze (EPM), novelty-suppressed feeding (NSF) tests at 1 but not 3 days after the surgery. Notably, at 7 and 14 days, the DPI mice again avoided the open arm, center area, and novelty environment in the EPM, open field, and NSF tests, respectively. In particular, DPI-induced social phobia and increased repetitive grooming did not occur until 14 days after surgery, suggesting that DPI-induced social anxiety requires a long time. Moreover, oral administration of an anti-inflammatory drug, ibuprofen, or an analgesic agent, ProTx-II, which is a selective inhibitor of NaV1.7 sodium channels, both significantly alleviated DPI-induced avoidance in mice. Finally, to investigate the underlying central mechanisms, we pharmacologically blocked a popular form of synaptic plasticity with a GluA2-derived peptide, long-term depression, as that treatment significantly prevented the development of anxiety phenotype upon DPI.ConclusionsTogether, these results suggest a temporally progressive causal relationship between orofacial pain and anxiety, calling for more in-depth mechanistic studies on concomitant pain and anxiety disorders.

A META-ANALYSIS OF COGNITIVE BEHAVIOR THERAPY AND MEDICATION FOR CHILD OBSESSIVE-COMPULSIVE DISORDER: MODERATORS OF TREATMENT EFFICACY, RESPONSE, AND REMISSION.

Individual randomized controlled trials (RCTs) have demonstrated the efficacy of cognitive behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) for the treatment of youth with obsessive-compulsive disorder (OCD). Although meta-analyses have confirmed these results, there has been minimal examination of treatment moderators or an examination of treatment response and symptom/diagnostic remission for these two treatment types. The present report examined the treatment efficacy, treatment response, and symptom/diagnostic remission for youth with OCD receiving either CBT or SRIs relative to comparison conditions, and examined treatment moderators. A comprehensive literature search identified 20 RCTs that met inclusion criteria, and produced a sample size of 507 CBT participants and 789 SRI participants. Random effects meta-analyses of CBT trials found large treatment effects for treatment efficacy (g = 1.21), treatment response (relative risk [RR] = 3.93), and symptom/diagnostic remission (RR = 5.40). Greater co-occurring anxiety disorders, therapeutic contact, and lower treatment attrition were associated with greater CBT effects. The number needed to treat (NNT) was three for treatment response and symptom/diagnostic remission. Random effects meta-analyses of SRI trials found a moderate treatment effect for treatment efficacy (g = 0.50), treatment response (RR = 1.80), and symptom/diagnostic remission (RR = 2.06). Greater methodological quality was associated with a lower treatment response for SRI trials. The NNT was five for treatment response and symptom/diagnostic remission. Findings demonstrate the treatment effects for CBT and SRIs across three important outcome metrics, and provide evidence for moderators of CBT across trials.

Treatment of Co-occurring Anxiety Disorders and Substance Use Disorders

Anxiety disorders commonly co-occur with substance use disorders both in the general population and in treatment-seeking samples. This co-occurrence is associated with greater symptom severity, higher levels of disability, and poorer course of illness relative to either disorder alone. Little research has been conducted, however, on the treatment of these co-occurring disorders. This gap may not only leave anxiety untreated or undertreated but also increase the risk for relapse and poor substance use outcomes. The aim of this article is to review the current state of the literature on treating co-occurring anxiety and substance use disorders. In addition to presenting a brief overview of the epidemiology of this co-occurrence, the article discusses the challenges in assessing anxiety in the context of a substance use disorder, the evidence for various treatment approaches, and recent advances and future directions in this understudied area. Also highlighted is the need for future research to identify optimal behavioral and pharmacologic treatments for co-occurring anxiety and substance use disorders.

Comorbidity and functional correlates of anxiety and physical conditions in Canadian Veterans

Introduction: Little is known about the relationship between anxiety disorders and physical conditions in Canadian Veterans. The purpose of this investigation was to examine the comorbidity of anxiety and physical conditions and their relation to physical and mental health–related quality of life and activity limitations in a nationally representative sample of Canadian Veterans. Methods: Participants were selected from the cross-sectional 2010 Survey on Transition to Civilian Life ( N = 3,154, response rate = 71.0%). The sample consisted of former Canadian Armed Forces Regular Force personnel who were released from 1998 to 2007. Multivariate logistic and linear regression models evaluated associations between several commonly occurring chronic physical conditions and any anxiety disorder and correlates (i.e., quality of life and activity limitations) of comorbidity. Results: Any anxiety disorder was associated with significantly elevated rates of cardiovascular, gastrointestinal, respiratory, and musculoskeletal conditions; diabetes; and chronic pain after controlling for sociodemographics, military characteristics, any mood disorder, and heavy drinking. However, when additionally controlling for number of physical conditions, any anxiety disorder remained significantly associated with gastrointestinal conditions (adjusted odds ratio [AOR] = 1.63, 99% confidence interval [CI] = 1.07–2.50) and chronic pain (AOR = 1.79, 99% CI = 1.15–2.78). Co-occurring anxiety disorders and musculoskeletal conditions were associated with poorer physical health–related quality of life and activity limitations than musculoskeletal conditions alone. Conclusion: Anxiety disorders and physical health problems co-occur at high rates among Canadian Veterans, and this comorbidity is linked to poorer physical health–related quality of life and activity limitations. These findings have implications for supporting at-risk personnel with the transition to civilian life and for informing health promotion and prevention efforts.

Generalized Anxiety Disorder and Pain.

In this article, the co-occurrence of anxiety disorders (in particular generalized anxiety disorder) and pain conditions is described, characteristics of chronic pain are explained, and data on the prevalence of co-comorbidity of both conditions are reviewed. Further, hypotheses on the possible psychosocial and neurobiological backgrounds of the high rate of co-occurrence are discussed. This review will also focus on the role of 'unexplained' pain syndromes (e.g. somatic symptom disorder and fibromyalgia) and anxiety. Finally, we address possible treatment strategies for patients with both conditions. There is a need for a rigorous assessment of pain syndromes in generalized anxiety disorder and anxiety in chronic pain conditions in order to prevent subsequent mortality by early treatment of both conditions.

Spatial structure of EEG in depression patients with co-occurring anxiety disorders

This study was carried out on 36 patients with reactive depression and recurrent depressive episodes accompanied by severe anxiety disorder. Cross-correlation analysis of the spatial structure of the brain bioelectric activity has been performed. It have been found that clinical features of depression and anxiety disorder affect the spatial EEG structure depending on the type of anxiety disorder.

Case-Series Evaluating a Transdiagnostic Cognitive-Behavioural Treatment for Co-occurring Anxiety Disorders.

Patients with anxiety disorder diagnoses commonly have more than one anxiety diagnosis. While cognitive-behavioural interventions have proven efficacy in treating single anxiety disorder diagnoses, there has been little investigation of their efficacy in treating co-occurring anxiety disorders. To evaluate the efficacy of a transdiagnostic cognitive-behavioural intervention for treating co-occurring anxiety disorders. An A-B single case study design (N = 6) was used to evaluate the efficacy of a 12 to 13-session modular transdiagnostic cognitive-behavioural intervention for treating co-occurring anxiety disorders across patients with at least two of the following diagnoses: GAD, Social Phobia, Panic Disorder and/or OCD. Five of the six participants completed treatment. At posttreatment assessment the five treatment completers achieved diagnostic and symptomatic change, with three participants being diagnosis free. All participants who completed treatment no longer met criteria for any DSM-IV-TR Axis-I diagnosis at the 3-month follow-up assessment, and demonstrated reliable and clinically-significant improvements in symptoms. Across the participants, statistically significant improvements from pre to postintervention were found on measures of anxiety, depression and general well-being, and all improvements were maintained at 3-month follow-up. Results suggest that transdiagnostic cognitive behavioural interventions can be of benefit to patients with co-occurring anxiety disorders.

A Qualitative Study of Career Exploration Among Young Adult Men With Psychosis and Co-occurring Substance Use Disorder

Objective: This article explores the meaning and importance of career exploration and career development in the context of integrated treatment for young adults with early psychosis and substance use disorders (i.e., co-occurring disorders). Methods: Twelve young adult men (aged 18 to 35 years) with co-occurring disorders recruited from an integrated treatment center completed a series of three semi-structured in-depth qualitative interviews. Data were transcribed verbatim and analyzed using thematic analysis. Purposive sampling ensured participants represented a range of substance abuse treatment stages. Results: Participants had a mean age of 26 (SD = 3) and identified as White. Two-thirds of participants (n = 8, 67%) had diagnosed schizophrenia-spectrum disorders, three (25%) had bipolar disorder, and one (8%) had major depression; four (33%) also had a co-occurring anxiety disorder. The most common substance use disorders involved cannabis (n = 8, 67%), cocaine (n = 5, 42%), and alcohol (n = 5, 42%). These young adult men with co-occurring disorders described past jobs that did not align with future goals as frustrating and disempowering, rather than confidence-building. Most young adult participants began actively developing their careers in treatment through future-oriented work or school placements. They pursued ambitious career goals despite sporadic employment and education histories. Treatment engagement and satisfaction appeared to be linked with career advancement prospects. Conclusions: Integrating career planning into psychosocial treatment is a critical task for providers who serve young adults with co-occurring disorders. Whether integrating career planning within early intervention treatment planning will improve clinical, functional, or economic outcomes is a promising area of inquiry for rehabilitation researchers and clinicians.

Differences in HPA-axis and heart rate responsiveness to psychosocial stress in children with autism spectrum disorders with and without co-morbid anxiety.

Children and adolescents with autism spectrum disorder (ASD) have much higher rates of anxiety disorders relative to their typically developing peers. However, there have been few attempts to investigate what physiological parameters may be associated with this elevated rate of anxiety. Therefore, this study investigated the physiological correlates of anxiety in ASD, with a focus on whether measures of heart rate and cortisol responsiveness to psychosocial stress differentiate those participants with ASD with and without a co-occurring anxiety disorder. A total of 75 male participants aged 10-16 years with normal intellectual ability underwent a psychosocial stress test. The participants included healthy controls (n=23), ASD only (ASD; n=20) and ASD with a comorbid anxiety disorder (ASDanx; n=32). Heart rate, heart rate variability and salivary cortisol were compared by fitting a piecewise regression model to examine baseline levels and change over time within and between the rest, stress and recovery phases of the stress test. The ASDanx group had different response patterns from both the ASD and control groups. The ASDanx group was characterized by a blunted cortisol and heart rate response to psychosocial stress. Furthermore, in the ASDanx group, reduced heart rate and cortisol responsiveness were significantly related to increased anxiety symptoms. This is the first study to report a possible physiological basis for co-occurring anxiety disorders in children and adolescents with ASD. It is possible that a non-adaptive physiological response to psychosocial stress may be related to the high prevalence of co-occurring anxiety disorders in people with ASD.

Not to Be Overshadowed or Overlooked: Functional Impairments Associated With Comorbid Anxiety Disorders in Youth With ASD

This study’s objective was to examine associations between comorbid anxiety disorders and difficulties commonly attributed to both anxiety and ASD (autism spectrum disorder) including self-injury, depressive symptoms, functional communication, social skill deficits and parent stress, in a well-characterized sample of youth with ASD. Fifty-nine verbally fluent participants (7–17 years; 93% Caucasian) diagnosed with ASD and their parents completed semistructured diagnostic interviews to confirm ASD diagnosis and assess for anxiety disorders. Parents completed questionnaires on child behavior and social skill as well as parental stress. Co-occurring anxiety disorders were associated with more parent-reported self-injurious behavior, depressive symptoms, and parental stress in youth with ASD, after controlling for other influential variables (e.g., ASD severity, cognitive ability, medication status). In contrast, youth with co-occurring anxiety disorders appeared to have significantly stronger parent-reported functional communication than youth with ASD alone as well as a comparable ability, according to parents, to initiate social interaction and develop relationships. Findings support a profile of challenges and relative strengths associated with the presence of anxiety disorders in youth with ASD. Though more research is needed to determine the direction of these associations, results provide further rationale for improving recognition and targeted treatment of this comorbidity in clinical practice.

Do Comorbid Anxiety Disorders Moderate the Effects of Psychotherapy for Bipolar Disorder? Results From STEP-BD

At least 50% of individuals with bipolar disorder have a lifetime anxiety disorder. Individuals with both bipolar disorder and a co-occurring anxiety disorder experience longer illness duration, greater illness severity, and poorer treatment response. The study explored whether comorbid lifetime anxiety in bipolar patients moderates psychotherapy treatment outcome. In the Systematic Treatment Enhancement Program randomized controlled trial of psychotherapy for bipolar depression, participants received up to 30 sessions of intensive psychotherapy (family-focused therapy, interpersonal and social rhythm therapy, or cognitive-behavioral therapy) or collaborative care, a three-session comparison treatment, plus pharmacotherapy. Using the number needed to treat, we computed effect sizes to analyze the relationship between lifetime anxiety disorders and rates of recovery across treatment groups after 1 year. A total of 269 patients (113 women) with a comorbid lifetime anxiety disorder (N=177) or without a comorbid lifetime anxiety disorder (N=92) were included in the analysis. Participants with a lifetime anxiety disorder were more likely to recover with psychotherapy than with collaborative care (66% compared with 49% recovered over 1 year; number needed to treat=5.88, small to medium effect). For patients without a lifetime anxiety disorder, there was no difference between rates of recovery in psychotherapy compared with collaborative care (64% compared with 62% recovered; number needed to treat=50, small effect). Participants with one lifetime anxiety disorder were likely to benefit from intensive psychotherapy compared with collaborative care (84% compared with 53% recovered; number needed to treat=3.22, medium to large effect), whereas patients with multiple anxiety disorders exhibited no difference in response to the two treatments (54% compared with 46% recovered; number needed to treat=12.5, small effect). Depressed patients with bipolar disorder and comorbid anxiety may be in particular need of additional psychotherapy for treating acute depression. These results need to be replicated in studies that stratify bipolar patients to treatments based on their anxiety comorbidity status.

Adjustment, depression, and anxiety in mild cognitive impairment and early dementia: a systematic review of psychological intervention studies

Many people with mild cognitive impairment (MCI) or early dementia suffer from concomitant depression and anxiety disorders, which in some cases, may be related difficulties adjusting to their diagnosis and associated cognitive problems. Successful adjustment and alleviation of depression and anxiety symptoms in these people is of critical importance for quality of life and may also help prevent, or delay, further cognitive decline. A variety of psychosocial intervention approaches has been trialed with this group. The literature was systematically searched for community-based intervention studies that aim to improve depression, anxiety, or adjustment. Studies were included or excluded using a priori criteria. Once included, the quality of studies was evaluated using pre-set criteria. Seventeen of 925 studies identified through literature databases and manual searches met the inclusion criteria. Of these, 16 were considered to be of at least "adequate quality." These included seven randomized controlled trials and eight pre-post studies. A diverse range of psychotherapeutic approaches, formats (individual or group), outcome measures, inclusion criteria, and cultural contexts were apparent, making comparisons between studies challenging. Several studies have demonstrated positive findings in the treatment of depression in older adults with early dementia using problem solving and modified cognitive behavior therapy (CBT) approaches. Amongst the large range of approaches trialed to improve adjustment and quality of life for patients with MCI and early dementia, some approaches, such as modified CBT, have shown promise. There is a need for replication studies using more rigorous methodology before clear clinical recommendations can be made.

Primary Care Utilization among Veterans with Chronic Musculoskeletal Pain: A Retrospective Chart Review

Patients with chronic pain have been shown to be more frequent utilizers of primary care, a contributor to increased health care costs. This study aimed to clarify which patient factors predict primary care utilization among veterans with chronic pain. Data were gathered from the electronic medical records of veterans who used Veterans Affairs primary care services from 2003 to 2009 in upstate New York. Chronic pain cases (N = 792) were those veterans diagnosed with a musculoskeletal condition of the hip, knee, or lower back during two or more primary care encounters over a period ≥ 3 months. Cases were frequency matched by age to controls, or those veterans who did not have a chronic musculoskeletal condition of the hip, knee, or lower back. Demographic information, medical and psychiatric diagnoses, medication use, and other health-related factors were used in regression models to predict primary care utilization. Cases consistently accrued more primary care encounters than controls during each year of the observation period. Cases also accrued more encounters from specialty medicine clinics, chronic pain clinics, and behavioral health clinics co-located in primary care. The contribution of mental health factors to care utilization differed by case-control status. Diagnosis of depression and substance use disorders were predictors of care utilization only among controls, whereas anxiety disorders, use of anxiolytics, and adjustment disorders were predictors only among cases. Cases with a co-occurring anxiety disorder had a greater than twofold increased risk (odds ratio = 2.36, 95% confidence interval = 1.32-4.22) of being in the top 10% of the distribution of total primary care utilization. Mental health conditions that commonly co-occur with chronic musculoskeletal pain contribute to greater health care utilization. Improved screening and early intervention for these disorders in primary care may improve patient outcomes and stem high rates of care utilization of veterans.

ATTENTION BIAS TO THREAT FACES IN SEVERE MOOD DYSREGULATION

We used a dot-probe paradigm to examine attention bias toward threat (i.e., angry) and happy face stimuli in severe mood dysregulation (SMD) versus healthy comparison (HC) youth. The tendency to allocate attention to threat is well established in anxiety and other disorders of negative affect. SMD is characterized by the negative affect of irritability, and longitudinal studies suggest childhood irritability predicts adult anxiety and depression. Therefore, it is important to study pathophysiologic connections between irritability and anxiety disorders. SMD patients (N = 74) and HC youth (N = 42) completed a visual probe paradigm to assess attention bias to emotional faces. Diagnostic interviews were conducted and measures of irritability and anxiety were obtained in patients. SMD youth differed from HC youth in having a bias toward threatening faces (P < .01). Threat bias was positively correlated with the severity of the SMD syndrome and depressive symptoms; degree of threat bias did not differ between SMD youth with and without co-occurring anxiety disorders or depression. SMD and HC youth did not differ in bias toward or away from happy faces. SMD youth demonstrate an attention bias toward threat, with greater threat bias associated with higher levels of SMD symptom severity. Our findings suggest that irritability may share a pathophysiological link with anxiety and depressive disorders. This finding suggests the value of exploring further whether attention bias modification treatments that are effective for anxiety are also helpful in the treatment of irritability.

Presentation and prevalence of PTSD in a bipolar disorder population: A STEP-BD examination

BackgroundCo-occurring psychiatric diagnoses have a negative impact on quality of life and change the presentation and prognosis of bipolar disorder (BD). To date, comorbidity research on patients with BD has primarily focused on co-occurring anxiety disorders and trauma history; only recently has there been a specific focus on co-occurring PTSD and BD. Although rates of trauma and PTSD are higher in those with bipolar disorder than in the general population, little is known about differences across bipolar subtypes. MethodsUsing the NIMH STEP-BD dataset (N=3158), this study evaluated whether there were baseline differences in the prevalence of PTSD between participants with bipolar disorder I (BDI) and bipolar disorder II (BDII), using the MINI and the Davidson Trauma Scale. Differences in PTSD symptom clusters between patients with BDI and BDII were also evaluated. ResultsA significantly greater proportion of participants with BDI had co-occurring PTSD at time of study entry (Χ2(1)=12.6; p<.001). BDI and BDII subgroups did not significantly differ in re-experiencing, avoidance, or arousal symptoms. LimitationsThe analysis may suggest a correlational relationship between PTSD and BD, not a causal one. Further, it is possible this population seeks treatment more often than individuals with PTSD alone. Finally, due to the episodic nature of BD and symptom overlap between the two disorders, misdiagnosis is possible. ConclusionsPTSD may be more prevalent in patients with BDI. However, the symptom presentation of PTSD appears similar across BD subtypes. Individuals should be thoroughly assessed for co-occurring diagnoses in an effort to provide appropriate treatment.

Treatment of borderline personality disorder and co-occurring anxiety disorders

Anxiety disorders are highly prevalent among individuals with borderline personality disorder, with comorbidity rates of up to 90%. Anxiety disorders have been found to reduce the likelihood of achieving remission from borderline personality disorder over time and to increase the risk of suicide and self-injury in this population. Evidence-based treatments for borderline personality disorder have not sufficiently focused on targeting anxiety disorders, and their effects on these disorders are either limited or unknown. Conversely, evidence-based treatments for anxiety disorders typically exclude suicidal, self-injuring, and seriously comorbid patients, thereby limiting their generalizability to individuals with borderline personality disorder. To address these limitations, recent research has begun to emerge focused on developing and evaluating treatments for individuals with co-occurring borderline personality disorder and anxiety disorders, specifically posttraumatic stress disorder (PTSD), with promising initial results. However, there is a need for additional research in this area, particularly studies evaluating the treatment of anxiety disorders among high-risk and complex borderline personality disorder patients.

Application of Depression Rating Scales in Patients with Parkinson's Disease with and without Co-Occurring Anxiety

In patients with Parkinson's disease (PD), depressive symptom rating scales facilitate identification of depressive disorders, which are common and disabling. Anxiety disturbances in PD, which lack valid assessment scales, frequently co-occur with PD-depression, are under-recognized, and require different interventions than depressive disorders. Whether high anxiety rates in PD confound depression scale performance or if any depression scales also predict anxiety disturbances is not known. To test the impact of co-occurring anxiety disorders on psychometric properties of depression rating scales in depressed PD patients and compare disability between PD patients with anxiety, depression, and comorbid anxiety and depressive disorders. PD subjects (n = 229) completed self-report and clinician-administered depression scales. Receiver operating characteristic curves were developed to estimate psychometric properties of each scale in those with depression alone, anxiety alone, and comorbid depression and anxiety. Between-group differences on all measures were examined. Comorbid anxiety did not affect the psychometric properties of any scale when identifying depressive disorders, but is associated with greater symptom severity and disability. Depression-scale scores were not significantly different between subjects with anxiety disorders only and those without depressive or anxiety diagnoses. Co-occurring anxiety disorders do not impact performance of depression rating scales in depressed PD patients. However, depression rating scales do not adequately identify anxiety disturbances alone or in patients with depression.

The presentation and classification of anxiety in autism spectrum disorder.

Research on the expression and prevalence of co-occurring anxiety disorders and autism spectrum disorders (ASDs) has produced variable results, in part due to the diversity in sample ascertainment and composition, methodology, and the operationalization of anxiety across studies. The present review organizes these findings to consider whether anxiety symptoms reported in ASD are better categorized as (a) a part of ASD or (b) a comorbid disorder. Although there is some support for the presence of co-occurring, potentially comorbid anxiety disorders in ASD, a shift toward measurement validation and dimensional approaches in future research is needed to determine the role of anxiety in ASD, particularly regarding its “typical” and “atypical” presentation in this population.