Tag Archives: comorbidity

“Why Anxiety is So Common for Those Diagnosed with Bipolar Disorder” by Natasha Tracy

19 Oct
From bipolar.answers.com:

Anxiety disorders are very common in people with bipolar disorder. In fact, in a major study (the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)), lifetime prevalence for a comorbid anxiety disorder reached 51.2% while rates for a current anxiety disorder reached 30.5%. It may be that anxiety is, inherently, a part of some people’s experience of bipolar or it may be entirely comorbid. Anxiety disorders are also known to exist even when the bipolar disorder is subsyndromal (with less that clinical symptoms).

People with bipolar disorder have been shown to frequently suffer from more anxiety subtypes as well. People with bipolar disorder commonly also experience generalized anxiety disorder, obsessive-compulsive disorder, simple phobia, social phobia, posttraumatic stress disorder, and panic disorder. (Note: Obsessive-compulsive disorder will no longer be considered an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders 5; rather it is considered its own type of disorder.)

What is An Anxiety Disorder?

Anxiety disorders come in many shapes and sizes (subtypes) and each type comes with its own list of symptoms. Symptoms of an anxiety disorder can include:

– Sleep disturbance

– Palpitations

– Trembling

– Chest pain

– Dizziness

– Feeling of detachment from the surroundings and from others

– Difficulty concentrating

– Exaggerated startle response

– And many others See: Symptoms of Anxiety Subtypes

What Impact Does an Anxiety Disorder Have on Bipolar?

Anxiety tends to have a worsening effect on bipolar disorder course and treatment. Bipolar symptoms appear to be intensified when anxiety is present. Those with comorbid anxiety also appear to have a lower age of disease onset, decreased response to standard treatments like lithium, increased rates of suicide and substance abuse, and a decreased quality of life. Impacts of anxiety disorder with existing bipolar disorder can be seen at school, work, and home.

“Maternal PTSD Linked to Children’s Trauma” by Kathleen Raven

12 Sep
from Reuters, reblogged from Trauma’s Labyrinth:

 

The children of mothers with posttraumatic stress disorder (PTSD) may be at high risk of being traumatized themselves, according to a small new study in urban U.S. neighborhoods.

Inner-city kids whose mothers had PTSD experienced more traumatic events – such as neighborhood shootings, domestic violence, dog bites or car accidents – before age five than kids whose mothers were depressed or had no mental health issues, researchers found.

Mothers with a combination of PTSD and depression were also more likely to report psychologically or physically abusing their child, compared to mothers with just one of those disorders.

“The main take-home message is that when parents are suffering, their children suffer, too,” said Dr. Howard Dubowitz, professor of pediatrics at University of Maryland School of Medicine in Baltimore.

“Those of us who are involved in helping to take care of kids can’t ignore what problems mothers and fathers may be struggling with,” added Dubowitz, who was not involved in the study.

Children exposed to trauma are themselves at greater risk of a mix of health challenges later on in life, such as obesity, drug and alcohol addictions, heart disease, suicide and mental health disorders, experts said.

“Everyone’s been putting the focus on depression, even though PTSD and depression run together,” said the study’s lead author Claude Chemtob, director of NYU Langone Medical Center’s family trauma research program.

He and his colleagues recruited 97 mothers with children between the ages three and five years old from Mount Sinai School of Medicine’s pediatric primary care clinics in New York City to participate in the study.

Most mothers were from ethnic minority groups and had high school diplomas. The women all completed questionnaires designed to detect depression or PTSD symptoms. They also answered questions about violent events their children had witnessed.

The majority of mothers were not clinically depressed or suffering from PTSD, Chemtob’s group reports in JAMA Pediatrics. Of the 97 mothers, 11 had diagnosable depression, six had PTSD and 10 had a combination of both.

Chemtob pointed out that the study population had slightly elevated levels of depression and PTSD diagnoses compared to national averages.

The researchers also found that mothers with PTSD and depression reported far greater parenting stress. “In short, their experience of parenting is that it is more difficult and less rewarding,” Chemtob said.

Last year the American Academy of Pediatrics urged pediatricians to take steps to reduce childhood “toxic stress” that can occur when parents or caregivers suffer from poor mental health.

In the current study, the children of mothers with PTSD witnessed an average of five traumatic events.

Their peers whose mothers were only depressed or had no mood disorder experienced an average of only one traumatic event. A third group of kids with mothers suffering both PTSD and depression experienced nearly four events.

Previous research suggests that nearly half of women with PTSD may also suffer from depression.

“We know that the effects of maternal mental health difficulties can be especially problematic in early life, from pregnancy to age 5,” Michelle Bosquet of Boston Children’s Hospital in Massachusetts told Reuters Health in an email.

Bosquet, who was not involved in the new study, added that much previous research has focused only on depression and less is known about how PTSD may influence parenting.

Researchers noted that the study is limited by its small size.

“These results have been found among certain families,” Dubowitz said. Future studies could look for the same results in different populations, such as whites, he said.

The authors encourage screening mothers for PTSD alongside depression in pediatric primary care settings. “This might be an effective way to intervene on child maltreatment,” Chemtob told Reuters Health.

In his research on child abuse, Dubowitz has created a questionnaire for parents to complete before arriving for a pediatric appointment. It contains two questions to detect depressive symptoms.

“It may be most efficient to use just two questions to identify possible depression, and, in so doing, identify parents with that condition and … help them get evaluated,” Dubowitz said.

“Aside from time, and time is very important, there is the whole challenge of changing health professionals’ practice and behavior,” he said.

SOURCE: http://bit.ly/1apSvqP JAMA Pediatrics, online September 2, 2013.

http://news.yahoo.com/maternal-ptsd-linked-childrens-trauma-153636958.html

“Posttraumatic Stress Disorder in Patients with Bipolar Disorder: A Review of Prevalence, Correlates, and Treatment Strategies” by Michael W. Otto et al

9 Aug
From PubMed:

 

Abstract

OBJECTIVES:

In this article, we review the evidence for, and implications of, a high rate of comorbid posttraumatic stress disorder (PTSD) in individuals with bipolar disorder.

METHODS:

We reviewed studies providing comorbidity data on patients with bipolar disorder, and also examined the PTSD literature for risk factors and empirically supported treatment options for PTSD.

RESULTS:

Studies of bipolar patients have documented elevated rates of PTSD. Based on our review, representing 1214 bipolar patients, the mean prevalence of PTSD in bipolar patients is 16.0% (95% CI: 14-18%), a rate that is roughly double the lifetime prevalence for PTSD in the general population. Risk factors for PTSD that are also characteristic of bipolar samples include the presence of multiple axis I disorders, greater trauma exposure, elevated neuroticism and lower extraversion, and lower social support and socio-economic status.

CONCLUSIONS:

These findings are discussed in relation to the cost of PTSD symptoms to the course of bipolar disorder. Pharmacological and cognitive-behavioral treatment options are reviewed, with discussion of modifications to current cognitive-behavioral protocols for addressing PTSD in individuals at risk for mood episodes.

 

http://www.ncbi.nlm.nih.gov/pubmed/15541062

New Study Finds High Rate of Bipolar Disorder in Postpartum Depression

19 Mar
from NAMI’s website; by Bob Carolla, NAMI Director of Media Relations:

The largest study to date of postpartum depression has found that one in seven women experience symptoms of depression after childbirth.

Published in JAMA Psychiatry by theAmerican MedicalAssociation, the basic finding is consistent with past prevalence estimates however, the study’s follow-up evaluations of women at risk revealed especially serious symptoms.

Approximately 20 percent of the mothers with depressive symptoms were experiencing suicidal thoughts. Among those who were followed for a full year, 22 percent experienced severe depression.

In the study, 10,000 mothers who gave birth at a Pittsburgh hospital were contacted by telephone and screened six to eight months later for symptoms of depression. Fourteen percent were identified as being at risk. Approximately 60 percent of the at-risk group received follow-up home visits. Another 11 percent completed diagnostic interviews by telephone

Forty percent of the women’ symptoms began postpartum. Thirty-three percent were assessed as having begun during pregnancy and 27 percent beforehand. Follow-up evaluations most often resulted in a diagnosis of depression with a co-occurring anxiety disorder.

“A striking 22.6 percent had bipolar disorder,” the study warned.

The study calls for all pregnant women and new mothers to be screened for depression, beyond what current medical practice requires. It also emphasizes the need for “strategies to differentiate women with bipolar from unipolar disorders.”

http://www.nami.org/template.cfm?Section=Top_Story&template=%2FContentManagement%2FContentDisplay.cfm&ContentID=152153&lstid=809

“How to Treat PTSD in Patients with Comorbid Mood Disorders” by Steven C. Dilsaver

11 Feb

This article from the journal Current Psychiatry reviews findings from studies the authors conducted about the relationship between PTSD and affective disorders, with a focus on the high rate of comorbidity with bipolar disorder. It concluded that Americans with bipolar disorder are 9.4 times more likely to have PTSD than the general population and that “PTSD is remarkably comorbid with mood disorders.” It strongly recommends that doctors screen patients with a bipolar diagnosis for PTSD. Read it, then print it and hand it to your shrink.

http://www.currentpsychiatry.com/pdf/0904/0904CP_Article2.pdf

“The Anxious Bipolar Patient: Strategies for Treatment” by Kavital Lohano and Rif S. El-Mallakh

4 Feb

http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1942536?pageNumber=1

A good overview of the relationship  between bipolar disorder and anxiety disorder, including PTSD.

“Sexual Abuse and Mental Health Sequelae” by Anita H. Clayton

3 Feb

http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=682

This article blew my mind. It looks at the relationship between childhood sexual abuse and the development of mental illness, as well as the risks of revictimization. I highly recommend it.

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