Is bipolar disorder specifically associated with panic disorder in youths?

OBJECTIVE: To replicate previous findings of high rates of bipolar disorder (BPD) in patients with panic disorder (PD) and determine if youths with both PD and BPD have more severe illness.
METHOD: 2025 youths aged 5 to 19 years seen at a mood and anxiety specialty clinic were assessed using the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present Episode, 4th Revision. Diagnoses were made using DSM-III and DSM-III-R criteria and then updated to conform to DSM-IV criteria. Patients were grouped into those with PD (N = 42), those with non-PD anxiety disorders (N = 407), and psychiatric controls with no anxiety diagnosis (N = 1576).
RESULTS: Youths with PD were more likely to exhibit comorbid BPD (N = 8, 19.0%) than youths with either non-PD anxiety disorders (N = 22, 5.4%) or other nonanxious psychiatric disorders (N = 112, 7.1%). The symptoms of PD and mania were not affected by the comorbidity between PD and BPD. Youths with both PD and BPD had more psychotic symptoms and suicidal ideation than patients with PD and other non-bipolar psychiatric disorders and BPD patients with other nonanxious comorbid disorders.
CONCLUSION: The presence of either PD or BPD in youths made the co-occurrence of the other condition more likely, as has been noted in adults. Patients with both PD and BPD are more likely to have psychotic symptoms and suicidal ideation. In treating youths with PD, clinicians must be vigilant for possible comorbid BPD or risk of pharmacologic triggering of a manic or hypomanic episode. Prospective studies are needed to learn if PD predicts the onset of BPD in children and adolescents.