Social phobia, panic disorder and suicidality in subjects with pure and depressive mania

Background: The objective of this study is to ascertain the rates of social phobia, panic disorder and suicidality in the midst of the manic state among subjects with pure and depressive mania. Methods: Subjects received evaluations entailing the use of serial standard clinical interviews, the Schedule for Affective Disorders and Schizophrenia (SADS) and a structured interview to determine whether they met the criteria for intra-episode social phobia (IESP) and panic disorder (IEPD). The diagnoses of major depressive disorder and mania were rendered using the Research Diagnostic Criteria. The diagnoses of IESP and IEPD were rendered using DSM-III-R criteria. Categorization as being suicidal was based on the,SADS suicide subscale score. Results: Twenty-five (56.8%) subjects had pure and 19 (43.2%) subjects had depressive mania. None of the subjects with pure and 13 (68.4%) with depressive mania had IESP (P<0.0001). One (4.0%) subject with pure and 16 (84.2%) subjects with depressive mania had IEPD (P<0.0001). One (4.0%) subject with pure and 12 (63.2%) subjects with depressive were suicidal. Twelve of 13 (92.3%) subjects with depressive mania met the criteria for IESP and IEPD concurrently (P<0.0001). All were suicidal. Limitations: The study suffers limitations imposed by small sample sizes and non-blind methods of identifying subjects with IESP, IEPD and who were suicidal. Conclusions: Subjects with depressive but not pure mania exhibited high rates of both IESP and IEPD. Concurrence of the disorders is the rule. The findings suggest that databases disclosing a relationship between panic disorder and suicidality merit, where possible, reanalysis directed at controlling for the effect of social phobia. (C) 2002 Elsevier B.V. All rights reserved.