Panic Disorder and Bipolar Disorder Among Military Servicemen - Comorbid or a Prodrome?

Abstract

Objective: This case series aims to describe three military personnel who presented with Panic Disorder (PD) subsequently develop Bipolar Disorder (BD) many years later. Methods: We identified three male personnel, presented to our psychiatric clinic with diagnosis conversion from PD to BD from 2016 to 2019. Age ranged from 25 - 33 during the first onset of symptoms. Results: All personnel seek psychiatric care outside the military health services. The mean duration between onset of symptoms and treatment was 5.5 years. Case 1 and 2 defaulted their follow up after a short course of treatment and returned with worsening symptoms and functioning. The mean time between PD diagnosis and the diagnostic shift to BD was 4.3 years. Case 3 was referred to a military psychiatrist one year after the first presentation to psychiatry services, showed better compliance with treatment and follow-up. This serviceman relatively had an earlier revision of diagnosis to BD as compared to Case 1 and 2. Case 1 and 2 showed more deterioration in symptoms and functioning, whereas Case 3 maintained his function with treatments. Conclusions: Psychiatrist and other mental health practitioners in the military need to be aware and routinely assess the possibility of panic attacks and anxiety symptoms to be prodromal of BD. Earlier recognition and revision of diagnosis will ensure a timely intervention delivered for better outcome and restoration of functioning in military personnel with BD.