Comorbid anxiety disorders are common in people with bipolar disorder. Generalised anxiety disorder is characterised by continuous and excessive worrying for six months or more. Specific phobias are characterised by anxiety provoked by a feared object or situation, resulting in avoidance. Social phobia is anxiety provoked by social or performance situations. Agoraphobia is anxiety about situations where escape may be difficult or where help might not be available. Panic disorder is characterised by a panic attack, which is a distinct episode where a person experiences sudden apprehension and fearfulness, and may experience shortness of breath, palpitations, chest pain or feeling of choking.

What is the evidence regarding anxiety disorders in people with bipolar disorder?

Moderate quality evidence found the lifetime prevalence of anxiety disorders in children, adolescents, and adults with bipolar disorder is around 45%, and the prevalence in adults in the euthymic phase is around 35%. These rates are significantly higher than in people without bipolar disorder.

The most common anxiety disorders in adults were generalised and social anxiety disorders, agoraphobia, specific phobias, and panic disorders. The most common anxiety disorders in children were generalised and separation anxiety disorders. The most common anxiety disorders in adolescents were panic disorder and social phobia.

Moderate to low quality evidence found cognitive behavioural therapy is effective for improving symptoms of anxiety in people with bipolar disorder.

Please also see the related topics on comorbid post-traumatic stress disorder and obsessive compulsive disorder, which are no longer considered anxiety disorders in the DSM-5.

October 2021

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Asthma has been initially believed to be a disorder of inflammation. In asthmatic patients, inflammatory cytokines are altered with asthma exacerbation. People with bipolar disorder are also found to have dysfunction of inflammation during various emotional states. As such, some researchers suggest that these two disorders may share similar mechanisms in their pathophysiology.

What is the evidence for the co-occurrence of asthma and bipolar disorder?

Moderate to high quality evidence finds a small increased risk of bipolar disorders in people with asthma. Lower quality evidence also found a small increased risk of asthma in those with bipolar disorders.

October 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

October 2021

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ADHD is a behavioural disorder characterised by inattention, hyperactivity, and impulsivity. The estimated prevalence in children under 18 years in the general population is around 5%. It is more prevalent in males than in females. ADHD can persist into adulthood with an estimated prevalence of 2.5% of ADHD in the adult general population. The DSM-5 requires that ADHD in adults began in childhood, with inattentive or hyperactive-impulsive symptoms needing to be present before age 12.

What is the evidence for rates of attention deficit hyperactivity disorder (ADHD) in people with bipolar disorder?

Moderate to high quality evidence finds around 17% of adults with bipolar disorder also have ADHD. Prevalence of ADHD was higher in small than in large studies and was higher in studies from Western Asia (Turkey and Iran) than in studies from America or Europe.

Conversely, around 8% of adults with ADHD also have bipolar disorder. Prevalence of bipolar disorder was higher in studies using the DSM than the ICD to diagnose bipolar disorder, and in studies from America than in studies from Europe or Taiwan. Age of bipolar disorder onset occurred earlier in those with ADHD than in those without ADHD.

Moderate quality evidence finds around 10% of children and youth with ADHD go on to develop bipolar disorder. This represents a large increase in the risk of bipolar disorder in children and youth with ADHD when compared to children and youth without any psychiatric disorder.

Moderate quality evidence finds a small increased risk of ADHD in people with bipolar disorder compared to people with major depression, and a medium-sized increased risk of ADHD in people with any mood disorder compared to people without any mood disorder. Prevalence of ADHD ranged from 17% in adults with bipolar disorder, to 43% in adolescents with bipolar disorder, to 73% in children with bipolar disorder.

October 2021

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Autoimmune disease occurs when the body attacks its own tissues due to an abnormally functioning immune system. Common autoimmune diseases include systemic lupus erythematosus, rheumatoid arthritis, psoriasis, multiple sclerosis, ulcerative colitis, Crohn’s disease, ankylosing spondylitis, pemphigus, and Sjogren’s syndrome.

What is the evidence for comorbid autoimmune disease?

Moderate quality evidence finds a significant, small increased rate of bipolar disorder in people with autoimmune disease, particularly sicca syndrome, systemic lupus erythematosus, and psoriasis.

Moderate to low quality evidence finds the prevalence of bipolar disorder in people with multiple sclerosis is ~6%. This finding is based on one study conducted in England, so may not be applicable to other populations.

October 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

October 2021

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What is the evidence for comorbid cancer?

Moderate to high quality evidence finds a small, significant increased risk of any cancer in people with bipolar disorder compared to people without bipolar disorder. Analysis containing only patients on lithium showed no increased rates of cancer.

October 2021

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People with bipolar disorder may show increased rates of co-occurring conditions when compared to general population rates. Cerebrovascular disease includes strokes, transient ischemic attacks, aneurysms, and vascular malformations. A stroke happens when blood flow to the brain is interrupted due to a blocked artery (ischaemic stroke) or when an artery bursts (haemorrhagic stroke). A transient ischemic attack is similar to a stroke, but less severe, and an aneurysm involves an enlarged artery caused by weakness in the arterial wall. These can all cause brain damage if cells do not get enough of the oxygen and nutrients that are carried by the blood to the brain.

What is the evidence for cerebrovascular disease in people with bipolar disorder?

Moderate quality evidence finds a small increase in cerebrovascular disease and stroke in people with bipolar disorder compared to people without bipolar disorder. The effect size was reduced, but remained significant in longitudinal studies, after adjustment for other variables that may have explained this association (e.g. co-occurring obesity, alcohol and substance-related disorders, diabetes, hypertension or hyperlipidemia).

October 2021

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Dementia is characterised by significant cognitive impairment. Symptoms include memory impairment, aphasia (impaired language functioning), apraxia (aberrant movement), agnosia (inability to identify objects, people, sound or smell), and impaired executive functioning (for example, the ability to think abstractly, plan, initiate or stop actions). Other symptoms include behavioural disturbances, anxiety, apathy, delirium, and mood and sleep disturbances.

What is the evidence for dementia in people with bipolar disorder?

Moderate quality evidence funds a medium-sized increased risk of dementia in people with the disorder compared to people without the disorder. Moderate to high quality evidence finds a medium-sized decreased risk of dementia in people with the disorder who are taking lithium compared to those not taking lithium.

October 2021

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People with bipolar disorder may show increased rates of unrelated co-occurring illnesses, one example is diabetes. Diabetes is a state of impaired insulin function, either as a result of reduced insulin production (type I diabetes) or reduced insulin responsiveness (type II diabetes). Insulin regulates blood glucose levels, and reduced insulin function effectively increases blood glucose levels (hyperglycaemia). This is a dangerous state in the long term, and can ultimately damage the retina, kidneys, nerves and blood vessels. Consequently, effective management of diabetes is crucial. It is unclear if any increased risk in people with bipolar disorder is purely a consequence of biological risk, the metabolic impact of antipsychotic administration, or unhealthy lifestyle choices, but it is likely a combination of many factors.

What is the evidence for comorbid diabetes?

Moderate quality evidence suggests the overall prevalence of type 2 diabetes in people with bipolar disorder is ~9.4%, with a small to medium-sized increased risk of diabetes when compared to age and gender-matched controls.

October 2021

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