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Treatment of anxiety disorders in patients with comorbid bipolar disorder

Anxiety disorders are the most prevalent comorbid diagnoses in patients with bipolar disorder (BD). A comorbid anxiety diagnosis can significantly impact the severity of bipolar symptoms, increase the risk of suicidality, and decrease psychosocial functioning and quality of life. The Canadian Networ...

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Autor principal: Ott, Carol A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: College of Psychiatric & Neurologic Pharmacists 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213896/
https://www.ncbi.nlm.nih.gov/pubmed/30397567
http://dx.doi.org/10.9740/mhc.2018.11.256
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author Ott, Carol A.
author_facet Ott, Carol A.
author_sort Ott, Carol A.
collection PubMed
description Anxiety disorders are the most prevalent comorbid diagnoses in patients with bipolar disorder (BD). A comorbid anxiety diagnosis can significantly impact the severity of bipolar symptoms, increase the risk of suicidality, and decrease psychosocial functioning and quality of life. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force published recommendations for treatment in 2012 suggesting that specific anticonvulsant mood stabilizers and second-generation antipsychotics are the medications of choice to treat these comorbidities. Serotonergic antidepressant medications are first-line medications for the treatment of most anxiety disorders; however, this can be problematic for a patient with BD. Antidepressant use in BD has been associated with a risk of manic switch as well as potential destabilization of mood. Mood stabilizer therapy should be established for patients with comorbid BD and an anxiety disorder before other medications are added to address the anxiety disorder. While benzodiazepine medications are recommended as third-line therapy in the CANMAT task force recommendations, their use should be avoided in patients with comorbid BD, posttraumatic stress disorder, and substance use disorders. The use of benzodiazepines should in general be avoided for all patients if possible, based upon current clinical research. Interpersonal, cognitive behavioral, and relaxation therapy are effective for the treatment of anxiety symptoms, especially emotional experiences, in patients who are euthymic.
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spelling pubmed-62138962018-11-05 Treatment of anxiety disorders in patients with comorbid bipolar disorder Ott, Carol A. Ment Health Clin Psychopharmacology Pearl Anxiety disorders are the most prevalent comorbid diagnoses in patients with bipolar disorder (BD). A comorbid anxiety diagnosis can significantly impact the severity of bipolar symptoms, increase the risk of suicidality, and decrease psychosocial functioning and quality of life. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force published recommendations for treatment in 2012 suggesting that specific anticonvulsant mood stabilizers and second-generation antipsychotics are the medications of choice to treat these comorbidities. Serotonergic antidepressant medications are first-line medications for the treatment of most anxiety disorders; however, this can be problematic for a patient with BD. Antidepressant use in BD has been associated with a risk of manic switch as well as potential destabilization of mood. Mood stabilizer therapy should be established for patients with comorbid BD and an anxiety disorder before other medications are added to address the anxiety disorder. While benzodiazepine medications are recommended as third-line therapy in the CANMAT task force recommendations, their use should be avoided in patients with comorbid BD, posttraumatic stress disorder, and substance use disorders. The use of benzodiazepines should in general be avoided for all patients if possible, based upon current clinical research. Interpersonal, cognitive behavioral, and relaxation therapy are effective for the treatment of anxiety symptoms, especially emotional experiences, in patients who are euthymic. College of Psychiatric & Neurologic Pharmacists 2018-11-01 /pmc/articles/PMC6213896/ /pubmed/30397567 http://dx.doi.org/10.9740/mhc.2018.11.256 Text en © 2018 CPNP. http://creativecommons.org/licenses/by-nc/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Psychopharmacology Pearl
Ott, Carol A.
Treatment of anxiety disorders in patients with comorbid bipolar disorder
title Treatment of anxiety disorders in patients with comorbid bipolar disorder
title_full Treatment of anxiety disorders in patients with comorbid bipolar disorder
title_fullStr Treatment of anxiety disorders in patients with comorbid bipolar disorder
title_full_unstemmed Treatment of anxiety disorders in patients with comorbid bipolar disorder
title_short Treatment of anxiety disorders in patients with comorbid bipolar disorder
title_sort treatment of anxiety disorders in patients with comorbid bipolar disorder
topic Psychopharmacology Pearl
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213896/
https://www.ncbi.nlm.nih.gov/pubmed/30397567
http://dx.doi.org/10.9740/mhc.2018.11.256
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