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Comorbid anxiety in phenotypes of pediatric bipolar disorder

Daniel P Dickstein1, Brendan A Rich, Anna B Binstock

  • 1Mood and Anxiety Disorders Program, Pediatrics and Developmental Neuropsychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20892-1255, USA. Dicksted@mail.nih.gov

Journal of Child and Adolescent Psychopharmacology
|September 30, 2005
PubMed

Insights

Pediatric bipolar disorder (BPD) shows high anxiety rates. Comorbid anxiety in the narrow BPD phenotype is linked to earlier onset and more severe impairment, suggesting a distinct, severe condition.

Area of Science:

  • Child and Adolescent Psychiatry
  • Mood Disorders
  • Anxiety Disorders

Background:

  • Limited research exists on anxiety in pediatric bipolar disorder (BPD).
  • Adult BPD studies indicate anxiety comorbidity is frequent and affects treatment outcomes.
  • Understanding anxiety's role in pediatric BPD phenotypes is crucial.

Purpose of the Study:

  • To explore the association between comorbid anxiety and two distinct phenotypes of pediatric BPD.
  • To investigate how anxiety impacts the presentation and severity of pediatric BPD.
  • To differentiate the role of anxiety in narrow versus broad BPD phenotypes.

Main Methods:

  • Study included two groups of children: "narrow phenotype" pediatric BPD (N=31) meeting DSM-IV mania criteria, and "broad phenotype" (ED; N=32) with chronic irritability.
  • DSM-IV criteria were used for the narrow BPD phenotype.
  • Anxiety prevalence and its association with BPD onset, age of onset, and hospitalizations were analyzed.

Main Results:

  • High anxiety prevalence was observed in both pediatric BPD (77.4%) and the ED group (46.9%).
  • In the narrow BPD phenotype, comorbid anxiety preceded BPD onset and was associated with an earlier age of BPD onset and increased hospitalizations.
  • No significant differences in symptom onset or hospitalizations were found between ED subjects with and without comorbid anxiety.

Conclusions:

  • Both narrow and broad phenotype pediatric BPD exhibit high rates of comorbid anxiety.
  • Comorbid anxiety is associated with greater functional impairment and earlier onset in the narrow BPD phenotype, suggesting a more severe presentation.
  • Pediatric BPD with comorbid anxiety may represent a particularly severe subtype of the disorder.
Abstract

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