[Bipolar disorders and psychiatric comorbidity]

Comorbidity is very frequent in bipolar disorders. The most frequently psychiatric disorders associated with bipolar disorders are substance use disorders (particularly alcohol abuse) and anxiety disorders. Obsessive-compulsive disorder, impulse control disorders, personality disorders and eating disorders co-occur also with bipolar disorder. Comorbidity complicates the diagnosis and the treatment of bipolar disorder and worsen the prognosis. For every bipolar patient, it is necessary to search for a comorbid psychiatric disorder, and vice-versa. There is a noticeable paucity of controlled studies to guide selection of the most effective treatment approches for these patients. The expert consensus guidelines about treatment of bipolar disorder propose divalproex as first-line treatment when bipolar disorder co-occurres with substance abuse, panic disorder or posttraumatic stress disorder.