Kessler (1994) reported the comorbidity of different psychotic disorders in the NCS and in the ECA. In both surveys, mania was accompanied by a comorbid disorder in more than 50% of the cases. Goodwin and Jamison (1990) argued that comorbidity in bipolar patients has not been studied as comprehensively as it has in major depressive disorder and stressed the importance of studying the effects of comorbidity in illness course. They summarized the existing literature and estimated a 35% prevalence of Bipolar Illness and alcohol abuse. They also raised the issue of determining the chronologic sequence of the onset of each disorder and the lack of much needed empirical information in this area.
The ECA study (Regier et al., 1990) reported that the Bipolar I group had a prevalence of substance abuse of 60.7%. The ECA investigators suggested that a high degree of comorbidity in bipolar disorders greatly complicates treatment. Interestingly, the ECA Study (Helzer and Pryzbeck, 1988) reported that the prevalence of comorbid alcoholism in mania was three times that in major depression. Furthermore, the likelihood (odds ratio) of an individual with bipolar disorder having a substance use disorder was 6.6 times greater than that of the general population. The only diagnosis that had a higher ratio than mania was antisocial personality disorder. Tohen et al. (2000) found in a treatment-based sample that the comorbidiy of substance use disorder in a cohort of first episode mania patient to be 17.3%. This finding suggests that in most cases the sequence of comorbid substance use disorder appears after the onset of bipolar disorder.
Comorbidiy of anxiety disorder has also been found to be frequent in bipolar disorder. Cosoff and Hafner (1998) found, in a treatment-based study conducted in Australia, a comorbidity prevalence of 17% for social phobia, 13% for generalized anxiety disorder, 30% of obsessive - compulsive disorder, and 15% for panic disorder.
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