Skip to main content

Advertisement

SpringerLink
Log in

Anxiety symptoms and syndromes in bipolar children and adolescents

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Anxiety disorders are relatively common in children and adolescents with bipolar disorder. Research to date indicates they may impact the onset, course, and treatment response of bipolar illness in children. Anxiety disorders often precede the onset of pediatric bipolar disorder. Family studies suggest first-degree relatives of bipolar patients are at increased risk for developing mood and anxiety disorders compared with relatives of individuals without mood disorders. Childhood adversity has been associated with higher rates of comorbid anxiety disorders and more severe illness course in bipolar patients. Preliminary study of the neurobiology of bipolar disorder with comorbid anxiety disorders suggests it may be neurophysiologically distinct from bipolar disorder without comorbid anxiety. Bipolar disorder with comorbid anxiety disorders has been associated with greater functional impairment and slower recovery. Prospective, longitudinal studies are needed to help us better understand the relationship between bipolar disorder and comorbid anxiety disorders so that opportunities for early intervention and effective treatment can be realized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Perlis RH, Sachiko M, Marangell LB, et al.: Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Biol Psychiatry 2004, 55:875–881.

    Article  PubMed  Google Scholar 

  2. Bell-Dolan DJ, Last CG, Strauss CC: Symptoms of anxiety disorders in normal children. J Am Acad Child Adolesc Psychiatry 1990, 29:759–765.

    Article  PubMed  CAS  Google Scholar 

  3. Greenhill LL, Pine D, March J, et al.: Assessment measures in anxiety disorders research. Psychopharmacol Bull 1998, 34:155–164.

    PubMed  CAS  Google Scholar 

  4. Kashani JH, Orvaschel H: A community study of anxiety in children and adolescents. Am J Psychiatry 1990, 147:313–318.

    PubMed  CAS  Google Scholar 

  5. Axelson DA, Birmaher B: Relation between anxiety and depressive disorders in childhood and adolescence. Depress Anxiety 2001, 14:67–78.

    Article  PubMed  CAS  Google Scholar 

  6. Cannon MF, Weems CF: Do anxiety and depression cluster into distinct groups? A test of tripartite model predictions in a community sample of youth. Depress Anxiety 2006, 23:453–460.

    Article  PubMed  Google Scholar 

  7. Freeman MP, Freeman SA, McElroy SL: The comorbidity of bipolar and anxiety disorders: prevalence, psychobiology, and treatment issues. J Affect Disord 2002, 68:1–23.

    Article  PubMed  Google Scholar 

  8. Johnson JG, Cohen P, Brook JS: Associations between bipolar disorder and other psychiatric disorders during adolescence and early adulthood: a community-based longitudinal investigation. Am J Psychiatry 2000, 157:1679–1681.

    Article  PubMed  CAS  Google Scholar 

  9. Brückl TM, Hans-Ulrich W, Höfler M, et al.: Childhood separation anxiety and the risk of subsequent psychopathology: results from a community study. Psychother Psychosom 2007, 76:47–56.

    Article  PubMed  Google Scholar 

  10. Henin A, Biederman J, Mick E, et al.: Childhood antecedent disorders to bipolar disorder in adults: a controlled study. J Affect Disord 2007, 99:51–57.

    Article  PubMed  Google Scholar 

  11. Lewinsohn PM, Klein DN, Seely JR, et al.: Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Am Acad Child Adolesc Psychiatry 1995, 34:454–463.

    Article  PubMed  CAS  Google Scholar 

  12. Kowatch RA, Youngstrom EA, Danielyan A, Findling RL: Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disord 2005, 7:483–496.

    Article  PubMed  Google Scholar 

  13. Findling RL, Gracious BL, McNamara NK, et al.: Rapid, continuous cycling and psychiatric co-morbidity in pediatric bipolar I disorder. Bipolar Disord 2001, 3:202–210.

    Article  PubMed  CAS  Google Scholar 

  14. Dickstein DP, Rich BA, Binstock AB, et al.: Comorbid anxiety in phenotypes of pediatric bipolar disorder. J Child Adolesc Psychopharmacol 2005, 15:534–538.

    Article  PubMed  Google Scholar 

  15. Axelson D, Birmaher B, Strober M, et al.: Phenomenology of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 2006, 63:1139–1148.

    Article  PubMed  Google Scholar 

  16. Faraone SV, Glatt SJ, Tsuang MT: The genetics of pediatric-onset bipolar disorder. Biol Psychiatry 2003, 53:970–977.

    Article  PubMed  Google Scholar 

  17. Hettema JM, Neale MC, Kendler KS: A review and meta-analysis of the genetic epidemiology of anxiety disorders. Am J Psychiatry 2001, 158:1568–1578.

    Article  PubMed  CAS  Google Scholar 

  18. Lapalme M, Hodgins S, LaRoche C: Children of parents with bipolar disorder: a metaanalysis of risk for mental disorders. Can J Psychiatry 1997, 42:623–631.

    PubMed  CAS  Google Scholar 

  19. Decina P, Kestenbaum CJ, Farber S, et al.: Clinical and psychological assessment of children of bipolar probands. Am J Psychiatry 1983, 140:548–553.

    PubMed  CAS  Google Scholar 

  20. Gershon ES, McKnew D, Cytryn L, et al.: Diagnoses in school-age children of affective disorder patients and normal controls. J Affect Disord 1985, 8:283–291.

    Article  PubMed  CAS  Google Scholar 

  21. Grigoroiu-Serbanescu M, Christodorescu D, Jipescu I, et al.: Psychopathology in children aged 10–17 of bipolar parents: psychopathology rate and correlates of the severity of the psychopathology. J Affect Disord 1989, 16:167–179.

    Article  PubMed  CAS  Google Scholar 

  22. Hammen C, Gordon D, Burge D, et al.: Maternal affective disorders, illness, and stress: risk for children’s psychopathology. Am J Psychiatry 1987, 144:736–741.

    PubMed  CAS  Google Scholar 

  23. Kashani JH, Burk JP, Horwitz B, et al.: Differential effect of subtype of parental major affective disorder on children. Psychiatry Res 1985, 15:195–204.

    Article  PubMed  CAS  Google Scholar 

  24. LaRoche C, Cheifetz P, Lester EP, et al.: Psychopathology in the offspring of parents with bipolar affective disorders. Can J Psychiatry 1985, 30:337–343.

    PubMed  CAS  Google Scholar 

  25. Zahn-Waxler C, Mayfield A, Radke-Yarrow M, et al.: A follow-up investigation of offspring of parents with bipolar disorder. Am J Psychiatry 1988, 145:506–509.

    PubMed  CAS  Google Scholar 

  26. DelBello MP, Geller B: Review of studies of child and adolescent offspring of bipolar parents. Bipolar Disord 2001, 3:325–334.

    Article  PubMed  CAS  Google Scholar 

  27. Duffy A, Alda M, Kutcher S, et al.: Psychiatric symptoms and syndromes among adolescent children of parents with lithium-responsive or lithium-nonresponsive bipolar disorder. Am J Psychiatry 1998, 155:431–433.

    PubMed  CAS  Google Scholar 

  28. Chang KD, Steiner H, Ketter TA: Psychiatric phenomenology of child and adolescent bipolar offspring. J Am Acad Child Adolesc Psychiatry 2000, 39:453–460.

    Article  PubMed  CAS  Google Scholar 

  29. Wals M, Hillegers MH, Reichart CG, et al.: Prevalence of psychopathology in children of a bipolar parent. J Am Acad Child Adolesc Psychiatry 2001, 40:1094–1102.

    Article  PubMed  CAS  Google Scholar 

  30. Henin A, Biederman J, Mick E, et al.: Psychopathology in the offspring of parents with bipolar disorder: a controlled study. Biol Psychiatry 2005, 58:554–561.

    Article  PubMed  Google Scholar 

  31. Wozniak B, Biederman J, Monuteaux MC, et al.: Parsing the comorbidity between bipolar disorder and anxiety disorders: a familial risk analysis. J Child Adolesc Psychopharmacol 2002, 12:101–111.

    Article  PubMed  Google Scholar 

  32. Caspi A, Sugden K, Moffitt TE, et al.: Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science 2003, 301:386–389.

    Article  PubMed  CAS  Google Scholar 

  33. Stein MB, Schork NJ, Gelernter J: Gene-by-environment (serotonin transporter and childhood maltreatment) interaction for anxiety sensitivity, an intermediate phenotype for anxiety disorders. Neuropsychopharmacology 2008, 33:312–319.

    Article  PubMed  CAS  Google Scholar 

  34. Leverich GS, McElroy SL, Suppes T, et al.: Early physical and sexual abuse associated with an adverse course of bipolar illness. Biol Psychiatry 2002, 51:288–297.

    Article  PubMed  Google Scholar 

  35. Marchand WR, Wirth L, Simon C: Adverse life events and pediatric bipolar disorder in a community mental health setting. Community Ment Health J 2005, 41:67–75.

    Article  PubMed  Google Scholar 

  36. Kent JM, Rauch SL: Neurocircuitry of anxiety disorders. Curr Psychiatry Rep 2003, 5:266–273.

    Article  PubMed  Google Scholar 

  37. DelBello MP, Adler CM, Strakowski SM: The neurophysiology of childhood and adolescent bipolar disorder. CNS Spectr 2006, 11:298–311.

    PubMed  Google Scholar 

  38. Caetano SC, Olvera RL, Glahn D, et al.: Fronto-limbic brain abnormalities in juvenile onset bipolar disorder. Biol Psychiatry 2005, 58:525–531.

    Article  PubMed  Google Scholar 

  39. Davidson RJ, Putnam KM, Larson CL: Dysfunction in the neural circuitry of emotion regulation-a possible prelude to violence. Science 2000, 289:591–594.

    Article  PubMed  CAS  Google Scholar 

  40. LeDoux JE: Emotion, memory and the brain. Sci Am 1994, 270:50–57.

    Article  PubMed  CAS  Google Scholar 

  41. Milham MP, Nugent AL, Drevets WC, et al.: Selective reduction in amygdala volume in pediatric anxiety disorders. Biol Psychiatry 2005, 57:961–966.

    Article  PubMed  Google Scholar 

  42. Rich BA, Vinton DT, Roberson-Nay R, et al.: Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder. Proc Natl Acad Sci U S A 2006, 103:8900–8905.

    Article  PubMed  CAS  Google Scholar 

  43. Brotman MA, Rich BA, Schmajuk M, et al.: Attention bias to threat faces in children with bipolar disorder and lifetime anxiety disorders. Biol Psychiatry 2007, 61:819–821.

    Article  PubMed  Google Scholar 

  44. Dilsaver SC, Akiskal HS, Akiskal KK, et al.: Dose-response relationship between number of comorbid anxiety disorders in adolescent/bipolar/unipolar disorders, and psychosis, suicidality, substance abuse, and familiality. J Affect Disord 2006, 96:249–258.

    Article  PubMed  Google Scholar 

  45. DelBello MP, Hanseman D, Adler CM, et al.: Twelve-month outcome of adolescents with bipolar disorder following first hospitalization for a manic or mixed episode. Am J Psychiatry 2007, 164:582–590.

    Article  PubMed  Google Scholar 

  46. Masi G, Toni C, Perugi G, et al.: Anxiety disorders in children and adolescents with bipolar disorder: a neglected comorbidity. Can J Psychiatry 2001, 46:797–802.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Children’s Hospital of Philadelphia, 3440 Market Street, Suite 200, Philadelphia, PA, 19104, USA

    Edith M. Jolin

Authors
  1. Edith M. Jolin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth B. Weller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ronald A. Weller
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jolin, E.M., Weller, E.B. & Weller, R.A. Anxiety symptoms and syndromes in bipolar children and adolescents. Curr Psychiatry Rep 10, 123–129 (2008). https://doi.org/10.1007/s11920-008-0022-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-008-0022-5

Keywords

Search

Navigation