Comorbid anxiety in bipolar CHOICE: Insights from the bipolar inventory of symptoms scale

Gustavo Kinrys; Charles L Bowden; Andrew A Nierenberg; Casey M Hearing; Alexandra K Gold; Dustin J Rabideau; Louisa G Sylvia; Keming Gao; Masoud Kamali; William V Bobo; Mauricio Tohen; Thilo Deckersbach; Susan L McElroy; Terence A Ketter; Richard C Shelton; Edward S Friedman; Joseph R Calabrese; Melvin G McInnis; James Kocsis; Michael E Thase; Vivek Singh; Noreen A Reilly-Harrington

doi:10.1016/j.jad.2018.12.039

Comorbid anxiety in bipolar CHOICE: Insights from the bipolar inventory of symptoms scale

J Affect Disord. 2019 Mar 1:246:126-131. doi: 10.1016/j.jad.2018.12.039. Epub 2018 Dec 18.

Authors

Gustavo Kinrys¹, Charles L Bowden², Andrew A Nierenberg³, Casey M Hearing⁴, Alexandra K Gold⁵, Dustin J Rabideau⁶, Louisa G Sylvia³, Keming Gao⁷, Masoud Kamali³, William V Bobo⁸, Mauricio Tohen⁹, Thilo Deckersbach³, Susan L McElroy¹⁰, Terence A Ketter¹¹, Richard C Shelton¹², Edward S Friedman¹³, Joseph R Calabrese⁷, Melvin G McInnis¹⁴, James Kocsis¹⁵, Michael E Thase¹⁶, Vivek Singh², Noreen A Reilly-Harrington³

Affiliations

¹ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: gkinrys@mgh.harvard.edu.
² Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA.
³ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁴ Department of Psychology, The George Washington University, Washington, DC, USA.
⁵ Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
⁶ Department of Biostatistics, Harvard University, Cambridge, MA, USA.
⁷ Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA.
⁸ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
⁹ Department of Psychiatry, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA.
¹⁰ Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹¹ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
¹² Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA.
¹³ Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
¹⁴ Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
¹⁵ Department of Psychiatry, Weill Cornell Medical College of Cornell University, New York, NY, USA.
¹⁶ Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.

PMID: 30580198
DOI: 10.1016/j.jad.2018.12.039

Abstract

Background: Approximately 86-89% of patients with BD have a comorbid anxiety disorder associated with poor quality of life and reduced likelihood of recovery from an acute mood episode. The purpose of this study is to assess the prevalence and impact of comorbid anxiety using the Bipolar Inventory of Symptoms Scale (BISS) in patients with BD who participated in a 6-month pragmatic trial.

Methods: Participants (N = 482) in the Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (CHOICE) study were adults with BD I or II. Anxiety diagnoses were assessed with the MINI. Global illness severity was assessed using the Clinical Global Impression-Bipolar Version. Mood symptoms and anxiety severity were assessed using the BISS.

Results: 61% of the study sample met criteria for a current anxiety disorder. Patients with a higher BISS anxiety score at baseline had a higher overall BD illness severity, depressive severity, and manic episode severity (p < 0.001). A single cutoff value of BISS anxiety had great sensitivity, yet poor specificity for determining a comorbid anxiety diagnosis. There were no significant differences in outcomes for individuals treated for anxiety disorders with anxiolytics compared with those who were not treated with anxiolytics.

Limitations: Sample size limitations prevented an analysis of whether the BISS cutoff score of 10 performed differently across varied anxiety disorders.

Conclusions: Given its ability to identify patients with co-occurring anxiety, the BISS anxiety subscale shows clinical utility as a screening measure though its application as a clinical assessment measure may not be advisable.

Keywords: Anxiety disorders; Bipolar disorder; Bipolar inventory of symptoms scale; Comparative effectiveness research; Mood disorders.

Publication types

Multicenter Study
Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
Anti-Anxiety Agents / therapeutic use
Antipsychotic Agents / therapeutic use
Anxiety Disorders / diagnosis*
Anxiety Disorders / drug therapy
Anxiety Disorders / epidemiology*
Bipolar Disorder / diagnosis*
Bipolar Disorder / drug therapy
Bipolar Disorder / epidemiology*
Comorbidity
Comparative Effectiveness Research
Female
Humans
Lithium / therapeutic use
Male
Middle Aged
Prevalence
Psychiatric Status Rating Scales*
Quality of Life
Quetiapine Fumarate / therapeutic use
Sensitivity and Specificity
Severity of Illness Index
Treatment Outcome
United States / epidemiology

Substances

Anti-Anxiety Agents
Antipsychotic Agents
Quetiapine Fumarate
Lithium