AFFECTIVE COMORBIDITY IN PANIC DISORDER - IS THERE A BIPOLAR CONNECTION

Although theoretical explanations for comorbidity in panic disorder (P D) abound in the literature, the complex clinical challenges of these patients have been neglected, especially where panic, obsessive-compul sive and 'soft' bipolar (e.g., hypomanic, cyclothymic and hyperthymic) conditions might co-exist. The aim of the present study has been to s ystematically explore the spectrum of intra-episodic and longitudinal comorbidity of 140 DSM-III-R PD patients - 67.1% of whom concomitantly met the criteria for Agoraphobia - and who were consecutively admitte d to the ambulatory service of the Psychiatric Clinic of the Universit y of Pisa over a 2-year period. Comorbidity with strictly defined anxi ety disorders - i.e., not explained as mere symptomatic extensions of PD - was relatively uncommon, and included Simple Phobia (10.7%), Soci al Phobia (6.4%), Generalized Anxiety Disorder (3.6%), and Obsessive-C ompulsive Disorder (4.2%). Comorbidity with Major Depression - strictl y limited to the melancholic subtype - occurred in 22.9%. Comorbidity with Bipolar Disorders included 2.1% with mania, 5% with hypomania, as well as 6.4% with cyclothymia, for a total of 13.5%; an additional 34 .3% of PD patients met the criteria for hyperthymic temperament. We su bmit that such comorbid patterns are at the root of unwieldy clinical constructs like 'atypical depression' and 'borderline personality'. Th e relationship of panic disorder to other anxious-phobic and depressiv e states has been known for some time. Our data extend this relationsh ip to soft bipolar disorders. Studies from other centers are needed to verify that the proposed new link is not merely due to referral bias to a tertiary university setting.