Introduction: an overview of the issues surrounding the recognition and management of bipolar disorder and comorbid anxiety.

n contrast to the relationship between substance abuse and bipolar disorder, the relationship between bipolar I disorder and anxiety disorders is vastly underexplored, underappreciated, and certainly understudied. This inattention is surprising in light of the fact that anxiety disorders have the highest rate of comorbidity with bipolar disorder , exceeding the comorbidity rate even of substance abuse. In addition, the impact of this comorbidity on the clinical course of bipolar disorder is severe. In response to this inattention, this set of articles will explore the relationship of bipolar disorders with anxiety symptoms and disorders. We will review data on the prevalence and impact of the relationship between these disorders. We will learn what is known about treatment in adults. We will examine and explore the comorbidity of anxiety disorders and bipolar disorder in youth. We will conclude with a discussion of the recognition and management of bipolar disorder and anxiety disorders in elderly populations. reviews the prevalence and impact of comorbid anxiety and bipolar disorder. He reports that over half of patients with bipolar disorder have at least one comorbid anxiety disorder, and nearly a third have multiple anxiety disorders. The most frequent comorbid anxiety disorder is generalized anxiety disorder. The impact of comorbid anxiety disorder on the course of bipolar disorder is substantial. Individuals with bipolar disorder and comorbid anxiety disorders, in general, have an age at onset of bipolar disorder 3 to 4 years earlier than those without anxiety disorders. Comorbidity predicts a more pernicious course of bipolar disorder than in those patients without comorbid disorders in terms of increased prevalence of suicide, worse response to treatment, increased number of psychotic and mixed features, and increased rates of neuropsychological dysfunction, as well as other negative outcomes. In addition, patients with bipolar disorder and comorbid anxiety have a higher rate of substance abuse. Quality of life in those with bipolar disorder and comorbid anxiety is severely compromised. Such individuals generally fare significantly worse in terms of work, family, and social impairment, as well as increased health care costs and strains on family than do those with bipolar disorder alone. Pharmacologic treatment considerations in comorbid and anxiety disorders in adults are addressed in the article no randomized, controlled clinical trials have been conducted with patients with comorbid bipolar disorder and anxiety disorders. However, a number of studies have been done on medications used in the treatment of patients with bipolar …