Anxious-bipolar comorbidity. Diagnostic and treatment challenges

This article describes multiple anxiety comorbidity in the setting of unstable bipolar syndromes, associated with alcohol and substance abuse. Also described are panic attacks during mania, social phobia followed by hypomania as well as bipolar disorder manifesting as episodic obsessive-compulsive disorder. The use of psychotropic combinations is necessary because of the syndromic complexity and the contrasting effects of pharmacologic treatments. The identification of differential patterns of comorbidity may provide important information in distinguishing more homogeneous clinical subtypes of affective disorders from the genetic, temperamental, and therapeutic point of view. The pattern of complex relationships among these disorders requires better-designed prospective observations. This is also true for putative temperamental (e.g. cyclothymia, interpersonal sensitivity) and personality (e.g. histrionic and borderline) factors, which might play a predisposing role in several clinically comorbid syndromes.