《Table 6 Treatment of anxiety disorder comorbidity in bipolar disorder》

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《Comorbidity of bipolar and anxiety disorders:An overview of trends in research》

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BD:Bipolar disorder；RCTs:Randomized controlled trials；SGAs:Second generation antipsychotics；SSRIs:Specific serotonergic reuptake inhibitors；CBT:Cognitive behavioural treatment.

Treatment of anxiety comorbidity in BD is challenging because of inherent difficulties in diagnosing comorbid bipolar and anxiety disorders and the high prevalence of inadequate response to treatment[6，10，17，18，172].Treatment options include both pharmacotherapy and psychotherapy.Only two randomized-controlled trials of medication treatment have been conducted in comorbid BD and anxiety disorders.One showed some efficacy for olanzapine and lamotrigine in treating anxiety symptoms[173]，while the other failed to show similar efficacy for risperidone[174].Therefore，findings from treatment of bipolar depression have been extrapolated to provide the necessary evidence-base for pharmacotherapy of anxiety comorbidity in BD[10，26，15，17，162].However，despite the lack of evidence there appeared to be considerable consensus that the primary aim of treatment is mood stabilization，although there was little agreement about the mood stabilizer of choice[6，7，9，10，162].Following mood stabilization，treatment with other specific medications might be considered.Options include second-generation antipsychotics，specific serotonergic reuptake inhibitors，anticonvulsants，and benzodiazepines，though each medication group appears to have its advantages and disadvantages[6，10，15，17，162].Although psychotherapy，particularly cognitive behavioural treatment is also recommended as a first-linetreatment option，the evidence base for cognitive behavioural treatment was meagre until recently[164].However，lately several new randomized-controlled trials of cognitive behavioural treatment have demonstrated its efficacy in treating anxiety symptoms in BD，making it a legitimate option for concomitant treatment of anxiety disorders in BD[165，168-171].