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Treatment implications for bipolar disorder co-occurring with anxiety syndromes and substance abuse 

Treatment implications for bipolar disorder co-occurring with anxiety syndromes and substance abuse
Chapter:
Treatment implications for bipolar disorder co-occurring with anxiety syndromes and substance abuse
Author(s):

Gustavo H. Vázquez

, Alberto Forte

, Sebastián Camino

, Leonardo Tondo

, and Ross J. Baldessarini

DOI:
10.1093/med/9780198748625.003.0017
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date: 23 August 2019

Anxiety symptoms and syndromes affect approximately half of both types I and II bipolar disorder (BD) patients at some time, more in women than men. Reported prevalence has ranked: generalized anxiety ≥ phobias ≥ panic ≥ post-traumatic stress syndrome ≥ obsessive–compulsive syndrome. BD associated with anxiety disorders is less responsive to mood-stabilizing treatments, with greater disability, substance abuse, and possibly suicidal risk. Emerging treatments for anxiety in BD patients include lurasidone, olanzapine, quetiapine, valproate, and psychotherapies, whereas the efficacy and safety of standard anxiolytics and antidepressants are not established. Abuse of alcohol, cannabis, stimulants, and opioids, alone or in combinations, also affects about half of BD patients at some time—more men than women and possibly somewhat more in type I than II. Substance abuse greatly complicates clinical care, contributing to erratic treatment-adherence, adverse outcomes, disability, increased risk of suicide or accidental death, and increased costs of care and from disability.

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