Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder

Arch Gen Psychiatry. 2002 Oct;59(10):905-11. doi: 10.1001/archpsyc.59.10.905.


Background: Given the observed association between panic disorder and bipolar disorder and the potential negative influence of panic symptoms on the course of bipolar illness, we were interested in the effects of what we have defined as "panic spectrum" conditions on the clinical course and treatment outcome in patients with bipolar I (BPI) disorder. We hypothesized that lifetime panic spectrum features would be associated with higher levels of suicidal ideation and a poorer response to acute treatment of the index mood episode in this patient population.

Methods: A sample of 66 patients with BPI disorder completed a self-report measure of lifetime panic-agoraphobic spectrum symptoms. Patients falling above and below a predefined clinical threshold for panic spectrum were compared for clinical characteristics, the presence of suicidal ideation during acute treatment, and acute treatment response.

Results: Half of this outpatient sample reported panic spectrum features above the predefined threshold. These lifetime features were associated with more prior depressive episodes, higher levels of depressive symptoms, and greater suicidal ideation during the acute-treatment phase. Patients with BPI disorder who reported high lifetime panic-agoraphobic spectrum symptom scores took 27 weeks longer than those who reported low scores to remit with acute treatment (44 vs 17 weeks, respectively).

Conclusions: The presence of lifetime panic spectrum symptoms in this sample of patients with BPI disorder was associated with greater levels of depression, more suicidal ideation, and a marked (6-month) delay in time to remission with acute treatment. Alternate treatment strategies are needed for patients with BPI disorder who endorse lifetime panic spectrum features.

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Agoraphobia / diagnosis
  • Agoraphobia / epidemiology
  • Agoraphobia / psychology
  • Anticonvulsants / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Bipolar Disorder / epidemiology
  • Bipolar Disorder / psychology
  • Bipolar Disorder / therapy*
  • Combined Modality Therapy
  • Comorbidity
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology
  • Depressive Disorder / therapy
  • Female
  • Humans
  • Lithium Carbonate / therapeutic use
  • Male
  • Middle Aged
  • Panic Disorder / diagnosis*
  • Panic Disorder / epidemiology
  • Panic Disorder / psychology
  • Personality Inventory
  • Psychotherapy / methods
  • Suicide / psychology
  • Treatment Outcome


  • Anticonvulsants
  • Antipsychotic Agents
  • Lithium Carbonate