High anxiety traits predict bipolarity in panic attacks, study.

Panic disorders frequently occur with affective disorders, particularly bipolar disorder. In addition, patients with bipolar disorder have a higher risk of intra-episode panic disorder during mania. The lack of information regarding bipolar disorder comorbidity in patients with panic disorder can negatively impact the choice of treatment and management, which is the reason why an early diagnosis of bipolar disorder in patients with panic disorder is important in the treatment outcome of patients.

A cross-sectional study published by Da Hye Oh et al in World Journals of Psychiatry showed that panic disorder patients with high anxiety trait were more likely to have bipolar symptoms.

Earlier, a family study of bipolar disorder showed that there is a possible complex genetic etiology in bipolar disorder and panic disorder comorbidity. The lifetime prevalence of panic disorder is approximately 21% of bipolar disorder, which is much higher than approximately 10% of major depressive disorder.

In other studies, patients with panic disorder and comorbid bipolar disorder had higher rates of suicidal behaviors, severe and longer depressive episodes, higher severity of illness scores, poorer treatment outcomes, and lower quality of life. In addition, they tend to have a higher risk of rapid switching and a shorter euthymic period.

Patients with bipolar disorder with high global anxiety levels developed a greater proportion of weeks in major depressive episodes[17]. Therefore, an early diagnosis of bipolarity in panic disorder patients is important to establish an appropriate treatment plan to improve the prognosis of patientsAntidepressants are often used in the treatment of panic disorder, and it is well known that antidepressant-induced manic symptoms are quite common in such patients.

The aim of this study was to investigate the psychological characteristics of panic disorder patients related to bipolarity. A total of 254 patients (136 men and 118 women) who were diagnosed with panic disorder were included in the study.

Panic disorder with bipolarity (BP+) was defined as a score of ≥ 7 on the Korean version of the Mood Disorder Questionnaire (K-MDQ), and a score lower than 7 was considered as a panic disorder without bipolarity (BP-).

Self-report questionnaires were analyzed to examine their association with bipolarity. Psychological tests used in the study were the Mood Disorder Questionnaire (MDQ), Panic Disorder Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Temperament and Character Inventory (TCI), and Minnesota Multiphasic Personality Inventory (MMPI).

Among the 254 subjects who were diagnosed with panic disorder, approximately 50% of the patients scored 7 or more on the K-MDQ, suggesting a history of manic/ hypomanic symptoms in the past.

Younger age and the Ma subscale of the MMPI were associated with the higher risk of bipolarity. In addition, the STAI (trait) score, which indicates the innate anxiety level, was positively related to the bipolarity of panic patients, while the self-directedness score in the TCI was negatively associated.

It was concluded that early diagnosis of bipolarity in patients with panic disorder will have a positive effect on the patient's treatment outcome.

It should be noted that among patients with panic disorder, patients with an anxious personality have a high comorbidity rate for bipolar disorder. Based on the results of this study, it is possible to detect bipolarity in advance through a simple questionnaire in actual clinical practice.

Source: World Journal of Psychiatry: Oh DH, Park DH, Ryu SH, Ha JH, Jeon HJ. Psychological predictors of bipolarity in panic disorder. World J Psychiatr 2021; 11(6): 242-252