Case-series Evaluating a Transdiagnostic Cognitive-behavioral Treatment For Co-occurring Anxiety Disorders.

Background. Patients with anxiety disorder diagnoses commonly have more than one anxiety diagnosis. While cognitive-behavioral interventions have proven efficacy in treating single anxiety disorder diagnoses, there has been little investigation of their efficacy in treating cooccurring anxiety disorders. Aims. To evaluate the efficacy of a transdiagnostic cognitive-behavioral intervention for treating co-occurring anxiety disorders. Methods. An A-B single case study design (N = 6) was used to evaluate the efficacy of a 12 to 13 session modular transdiagnostic cognitive-behavioral intervention for treating co-occurring anxiety disorders across patients with at least two of the following diagnoses: GAD, Social Phobia, Panic Disorder and/or OCD. Results. Five of the six participants completed treatment. At post-treatment assessment the five treatment completers achieved diagnostic and symptomatic change with three participants being diagnosis free. All participants who completed treatment no longer met criteria for any DSM-IV-TR Axis-I diagnosis at the three-month follow-up assessment, and demonstrated reliable and clinically-significant improvements in symptoms. Across the participants, statistically significant improvements from pre- to post-intervention were found on measures of anxiety, depression and general well-being, and all improvements were maintained at three-month follow-up. Conclusions. Results suggest that transdiagnostic cognitive behavioral interventions can be of benefit to patients with co-occurring anxiety disorders.

Comorbid Migraine in Major Depressive Disorder Suggests a Subgroup Related to Bipolar Disorder

Aims: Previous small-scale studies suggest presence of migraine in major depressive disorder (MDD) is associated with specific clinical characteristics that may overlap with those of bipolar disorder. We aimed to compare a broad range of characteristics in participants who have MDD with and without migraine, and to explore possible similarities between those characteristics associated with the presence of migraine in MDD and those in bipolar disorder in a large UK sample. Methods: Lifetime and episodic clinical characteristics and affective temperaments in DSM-IV MDD with (n=134) and without (n=218) migraine were compared. Characteristics associated with the presence of migraine were then compared with a sample of participants with DSM-IV bipolar disorder (n=407). All participants were recruited into the Bipolar Disorder Research Network (www.bdrn.org). Results: The presence of migraine in MDD was associated with female gender (76.9% vs 56.9%, p<0.001), younger age of onset (23 vs 27 years, p=0.002), history of attempted suicide (38.3% vs 22.7%, p=0.002), and more panic/agoraphobia symptomatology (6 vs 4, p<0.001). Female gender (OR=2.44, p=0.006) and younger age of onset (OR=0.97, p=0.013) remained significant in a multivariate model. These clinical characteristics were not significantly different to those of our participants with bipolar disorder. Conclusions: The presence of migraine in MDD delineates a subgroup of individuals with a more severe illness course. The clinical presentation of this subgroup more closely resembles that of bipolar disorder than that of MDD without migraine. The presence of migraine in major depression may be a marker of a specific subgroup that could be useful in future research.

Epilepsy in Bipolar Disorder: Impact on Clinical Features, Course and Outcome

Background and Aims: It is well recognized that mood disorders and epilepsy commonly co-occur. However, the relationship between epilepsy and the clinical features and course of illness in bipolar disorder (BD) is currently unknown. Here we explore the rate of epilepsy within a large sample of individuals with BD and examine bipolar illness characteristics according to the presence or absence of epilepsy. Methods: 1596 participants recruited to the Bipolar Disorder Research Network; a well-defined sample of UK subjects with a diagnosis of BD, completed a self-report questionnaire to assess lifetime history of epilepsy (Ottman et al., 2010). A subset of participants (n = 29) completed a telephone interview assessment to determine expert-confirmed epilepsy status. Lifetime clinical characteristics of illness were compared between BD subjects with and without a history of epilepsy. Results: 127 individuals (8%) screened positively for lifetime history of epilepsy. Bipolar subjects with epilepsy experienced higher rates of: suicide attempt (64.2% vs. 47.4%, p = 0.000367); panic disorder (29.6% vs. 16.1%, p = 0.001); phobias (13.6% vs. 5.7%, 0.004); alcohol abuse (18.6% vs. 10.6%, p = 0.017); and other substance abuse (10.2% vs. 4%, p = 0.009). History of suicide attempt (OR = 1.79, p = 0.013) remained significant within a multivariate model. Similar trends were observed within bipolar subjects with well-defined, expert-confirmed epilepsy (n = 29). Conclusions: Results demonstrate an increased rate of self-reported epilepsy in the BD sample, compared to the general population, and suggest differences in the clinical course of BD according to the presence of epilepsy. Comorbid epilepsy within BD may provide an attractive opportunity for subcategorising for future genetic studies, potentially identifying common underlying mechanisms.