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Oliva V, De Prisco M, Pons-Cabrera MT, Guzmán P, Anmella G, Hidalgo-Mazzei D, Grande I, Fanelli G, Fabbri C, Serretti A, Fornaro M, Iasevoli F, de Bartolomeis A, Murru A, Vieta E, Fico G. Machine Learning Prediction of Comorbid Substance Use Disorders among People with Bipolar Disorder. J Clin Med 2022; 11:3935. [PMID: 35887699 PMCID: PMC9315469 DOI: 10.3390/jcm11143935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 02/05/2023] Open
Abstract
Substance use disorder (SUD) is a common comorbidity in individuals with bipolar disorder (BD), and it is associated with a severe course of illness, making early identification of the risk factors for SUD in BD warranted. We aimed to identify, through machine-learning models, the factors associated with different types of SUD in BD. We recruited 508 individuals with BD from a specialized unit. Lifetime SUDs were defined according to the DSM criteria. Random forest (RF) models were trained to identify the presence of (i) any (SUD) in the total sample, (ii) alcohol use disorder (AUD) in the total sample, (iii) AUD co-occurrence with at least another SUD in the total sample (AUD+SUD), and (iv) any other SUD among BD patients with AUD. Relevant variables selected by the RFs were considered as independent variables in multiple logistic regressions to predict SUDs, adjusting for relevant covariates. AUD+SUD could be predicted in BD at an individual level with a sensitivity of 75% and a specificity of 75%. The presence of AUD+SUD was positively associated with having hypomania as the first affective episode (OR = 4.34 95% CI = 1.42-13.31), and the presence of hetero-aggressive behavior (OR = 3.15 95% CI = 1.48-6.74). Machine-learning models might be useful instruments to predict the risk of SUD in BD, but their efficacy is limited when considering socio-demographic or clinical factors alone.
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Affiliation(s)
- Vincenzo Oliva
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St., 12-0, 08036 Barcelona, Catalonia, Spain; (V.O.); (M.D.P.); (G.A.); (D.H.-M.); (I.G.); (A.M.); (G.F.)
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (G.F.); (C.F.); (A.S.)
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St., 12-0, 08036 Barcelona, Catalonia, Spain; (V.O.); (M.D.P.); (G.A.); (D.H.-M.); (I.G.); (A.M.); (G.F.)
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, 80131 Naples, Italy; (M.F.); (F.I.); (A.d.B.)
| | - Maria Teresa Pons-Cabrera
- Addictions Unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St., 12-0, 08036 Barcelona, Catalonia, Spain; (M.T.P.-C.); (P.G.)
| | - Pablo Guzmán
- Addictions Unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St., 12-0, 08036 Barcelona, Catalonia, Spain; (M.T.P.-C.); (P.G.)
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St., 12-0, 08036 Barcelona, Catalonia, Spain; (V.O.); (M.D.P.); (G.A.); (D.H.-M.); (I.G.); (A.M.); (G.F.)
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St., 12-0, 08036 Barcelona, Catalonia, Spain; (V.O.); (M.D.P.); (G.A.); (D.H.-M.); (I.G.); (A.M.); (G.F.)
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St., 12-0, 08036 Barcelona, Catalonia, Spain; (V.O.); (M.D.P.); (G.A.); (D.H.-M.); (I.G.); (A.M.); (G.F.)
| | - Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (G.F.); (C.F.); (A.S.)
- Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, 6525 GD Nijmegen, The Netherlands
| | - Chiara Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (G.F.); (C.F.); (A.S.)
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 9NU, UK
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (G.F.); (C.F.); (A.S.)
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, 80131 Naples, Italy; (M.F.); (F.I.); (A.d.B.)
| | - Felice Iasevoli
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, 80131 Naples, Italy; (M.F.); (F.I.); (A.d.B.)
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, 80131 Naples, Italy; (M.F.); (F.I.); (A.d.B.)
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St., 12-0, 08036 Barcelona, Catalonia, Spain; (V.O.); (M.D.P.); (G.A.); (D.H.-M.); (I.G.); (A.M.); (G.F.)
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St., 12-0, 08036 Barcelona, Catalonia, Spain; (V.O.); (M.D.P.); (G.A.); (D.H.-M.); (I.G.); (A.M.); (G.F.)
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St., 12-0, 08036 Barcelona, Catalonia, Spain; (V.O.); (M.D.P.); (G.A.); (D.H.-M.); (I.G.); (A.M.); (G.F.)
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Grunze H, Soyka M. The pharmacotherapeutic management of comorbid bipolar disorder and alcohol use disorder. Expert Opin Pharmacother 2022; 23:1181-1193. [PMID: 35640575 DOI: 10.1080/14656566.2022.2083500] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Comorbidity of bipolar disorder (BD) and alcohol use disorder (AUD) is very frequent resulting in detrimental outcomes, including increased mortality. Diagnosis of AUD in BD and vice versa is often delayed as symptoms of one disorder mimic and obscure the other one. Evidence for pharmacotherapies for people with comorbid BD and AUD remains limited, and further proof-of-concept studies are urgently needed. AREAS COVERED This paper explores the currently available pharmacotherapies for AUD, BD and their usefulness for comorbid BD and AUD. It also covers to some degree the epidemiology, diagnosis, and potential common neurobiological traits of comorbid BD and AUD. EXPERT OPINION The authors conclude that more controlled studies are needed before evidence-based guidance can be drawn up for clinician's use. Since there are no relevant pharmacological interactions, approved medications for AUD can also be used safely in BD. For mood stabilization, lithium should be considered first in adherent persons with BD and comorbid AUD. Alternatives include valproate, lamotrigine, and some atypical antipsychotics, with partial D2/D3 receptor agonism possibly being beneficial in AUD, too.
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Affiliation(s)
- Heinz Grunze
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany.,Paracelsus Medical University, Nuremberg, Germany
| | - Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians- University Munich, Munich, Germany
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3
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Selloni A, Bhatia G, Ranganathan M, De Aquino JP. Multimodal Correlates of Cannabis Use among U.S. Veterans with Bipolar Disorder: An Integrated Study of Clinical, Cognitive, and Functional Outcomes. J Dual Diagn 2022; 18:81-91. [PMID: 35430960 PMCID: PMC9794455 DOI: 10.1080/15504263.2022.2053264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: Cannabis use (CU) is common among persons with bipolar disorder (BD). Evidence suggests that CU is associated with poorer outcomes among persons with BD; however, these findings remain inconsistent. The present exploratory study aims to examine clinical, functional, and cognitive correlates of CU among persons with BD. Methods: U.S. veterans with BD type I who participated in a large-scale, nationwide study were categorized into four groups: current CU, past CU, past other drug use, and no drug use. Bivariate analyses, univariate analyses of covariance, and Levene's Test for Equality of Variance were used to compare groups on clinical, cognitive, and functional measures. Results: Of 254 (84.6% male) veterans with BD type I included in the analyses, 13 (5.1%) had current CU, 37 (14.5%) past CU, 77 (30.3%) past other drug use, and 127 (50%) reported no drug use. BD with CU was associated with post-traumatic stress disorder (PTSD) and experiencing lifetime suicidal ideation. Notably, current CU was associated with higher working memory performance, compared to both past CU and no drug use. Likewise, current CU was associated with higher functional capacity, compared to past CU as well as no drug use. Conclusions: These findings contribute to the growing literature on the complex effects of cannabis on BD. As the commercialization and legalization of cannabis increases, further research in this area is warranted to quantify posed risks to this population, and thereby guide clinical decision-making.
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Affiliation(s)
- Alexandria Selloni
- VA Connecticut Healthcare System, 950 Campbell Avenue, Building 36/116A4, West Haven, CT 06516, USA
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
| | | | - Mohini Ranganathan
- VA Connecticut Healthcare System, 950 Campbell Avenue, Building 36/116A4, West Haven, CT 06516, USA
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
| | - Joao P. De Aquino
- VA Connecticut Healthcare System, 950 Campbell Avenue, Building 36/116A4, West Haven, CT 06516, USA
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
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Ociskova M, Prasko J, Kantor K, Hodny F, Kasyanik P, Holubova M, Vanek J, Slepecky M, Nesnidal V, Minarikova Belohradova K. Schema Therapy for Patients with Bipolar Disorder: Theoretical Framework and Application. Neuropsychiatr Dis Treat 2022; 18:29-46. [PMID: 35023920 PMCID: PMC8747790 DOI: 10.2147/ndt.s344356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022] Open
Abstract
Bipolar disorder (BD) is a severe mood disorder characterized by episodes of depression and hypomania or mania. Despite its primarily biological roots, the onset and course of the disorder have also been related to psychosocial factors such as early adverse experiences and related maladaptive schemas. Several researchers proposed a schema therapeutic model to treat patients with BD. In this paper, we further develop the theoretical model and elaborate on seven elements that were found effective in the psychosocial interventions with individuals with BD: monitoring mood and early symptoms of relapse, recognizing and management of stressful situations and interpersonal conflicts, creating a relapse prevention plan, stabilizing the sleep/wake cycle and daily routine, encouraging the use of medication, and reducing self-stigma and substance use. Apart from that, we describe the elements of the schema work with patients who suffer from BD. Illustrative clinical cases accompany the theoretical framework. The research of the schema therapy with patients with severe mental illnesses has only recently started developing. The presented paper also aims to encourage further research in this area and highlight potentially beneficial research goals.
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Affiliation(s)
- Marie Ociskova
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic.,Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic
| | - Krystof Kantor
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | | | - Michaela Holubova
- Department of Pedagogy and Psychology, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, The Czech Republic.,Department of Psychiatry, Regional Hospital Liberec, Liberec, The Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Vlastimil Nesnidal
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Kamila Minarikova Belohradova
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
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Icick R, Melle I, Etain B, Høegh MC, Gard S, Aminoff SR, Leboyer M, Andreassen OA, Belzeaux R, Henry C, Bjella TD, Kahn JP, Steen NE, Bellivier F, Lagerberg TV. Preventive Medication Patterns in Bipolar Disorder and Their Relationship With Comorbid Substance Use Disorders in a Cross-National Observational Study. Front Psychiatry 2022; 13:813256. [PMID: 35592382 PMCID: PMC9110763 DOI: 10.3389/fpsyt.2022.813256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The potential role of sub-optimal pharmacological treatment in the poorer outcomes observed in bipolar disorder (BD) with vs. without comorbid substance use disorders (SUDs) is not known. Thus, we investigated whether patients with BD and comorbid SUD had different medication regimens than those with BD alone, in samples from France and Norway, focusing on compliance to international guidelines. METHODS Seven hundred and seventy patients from France and Norway with reliably ascertained BD I or II (68% BD-I) were included. Medication information was obtained from patients and hospital records, and preventive treatment was categorized according to compliance to guidelines. We used Bayesian and regression analyses to investigate associations between SUD comorbidity and medication. In the Norwegian subsample, we also investigated association with lack of medication. RESULTS Comorbid SUDs were as follows: current tobacco smoking, 26%, alcohol use disorder (AUD), 16%; cannabis use disorder (CUD), 10%; other SUDs, 5%. Compliance to guidelines for preventive medication was lacking in 8%, partial in 44%, and complete in 48% of the sample. Compliance to guidelines was not different in BD with and without SUD comorbidity, as was supported by Bayesian analyses (highest Bayes Factor = 0.16). Cross national differences in treatment regimens led us to conduct country-specific adjusted regression analyses, showing that (1) CUD was associated with increased antipsychotics use in France (OR = 2.4, 95% CI = 1.4-3.9, p = 0.001), (2) current tobacco smoking was associated with increased anti-epileptics use in Norway (OR = 4.4, 95% CI = 1.9-11, p < 0.001), and (3) AUD was associated with decreased likelihood of being medicated in Norway (OR = 1.2, 95% CI = 1.04-1.3, p = 0.038). CONCLUSION SUD comorbidity in BD was overall not associated with different pharmacological treatment in our sample, and not related to the level of compliance to guidelines. We found country-specific associations between comorbid SUDs and specific medications that warrant further studies.
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Affiliation(s)
- Romain Icick
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,FondaMental Foundation, Créteil, France.,INSERM U1144, Université Paris Cité, Paris, France
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bruno Etain
- FondaMental Foundation, Créteil, France.,INSERM U1144, Université Paris Cité, Paris, France.,Université Paris Cité, Paris, France.,Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris, France
| | - Margrethe Collier Høegh
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sébastien Gard
- INSERM U1144, Université Paris Cité, Paris, France.,Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Pôle de Psychiatrie Générale et Universitaire (3/4/7), Bordeaux, France
| | - Sofie R Aminoff
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Marion Leboyer
- FondaMental Foundation, Créteil, France.,Paris Est Créteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), HU Henri Mondor, Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Fédération Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Créteil, France
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Raoul Belzeaux
- Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital Sainte-Marguerite, Pôle de Psychiatrie, INT-UMR 7289, CNRS, Aix-Marseille University, Marseille, France
| | - Chantal Henry
- Université Paris Cité, Paris, France.,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Thomas D Bjella
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jean-Pierre Kahn
- Université de Lorraine, CHRU de Nancy et Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, Laxou, France
| | - Nils Eiel Steen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Frank Bellivier
- FondaMental Foundation, Créteil, France.,INSERM U1144, Université Paris Cité, Paris, France.,Université Paris Cité, Paris, France.,Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris, France
| | - Trine Vik Lagerberg
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Preuss UW, Schaefer M, Born C, Grunze H. Bipolar Disorder and Comorbid Use of Illicit Substances. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111256. [PMID: 34833474 PMCID: PMC8623998 DOI: 10.3390/medicina57111256] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
Substance use disorders (SUD) are highly prevalent in bipolar disorder (BD) and significantly affect clinical outcomes. Incidence and management of illicit drug use differ from alcohol use disorders, nicotine use of behavioral addictions. It is not yet clear why people with bipolar disorder are at higher risk of addictive disorders, but recent data suggest common neurobiological and genetic underpinnings and epigenetic alterations. In the absence of specific diagnostic instruments, the clinical interview is conducive for the diagnosis. Treating SUD in bipolar disorder requires a comprehensive and multidisciplinary approach. Most treatment trials focus on single drugs, such as cannabis alone or in combination with alcohol, cocaine, or amphetamines. Synopsis of data provides limited evidence that lithium and valproate are effective for the treatment of mood symptoms in cannabis users and may reduce substance use. Furthermore, the neuroprotective agent citicoline may reduce cocaine consumption in BD subjects. However, many of the available studies had an open-label design and were of modest to small sample size. The very few available psychotherapeutic trials indicate no significant differences in outcomes between BD with or without SUD. Although SUD is one of the most important comorbidities in BD with a significant influence on clinical outcome, there is still a lack both of basic research and clinical trials, allowing for evidence-based and specific best practices.
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Affiliation(s)
- Ulrich W. Preuss
- Klinik für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640 Ludwigsburg, Germany
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther-Universität, Halle-Wittenberg, Julius-Kühn-Str. 7, 06112 Halle/Saale, Germany
- Correspondence:
| | - Martin Schaefer
- Klinik für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136 Essen, Germany;
- Klinik für Psychiatrie und Psychotherapie (CCM), Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Christoph Born
- Psychiatrie Schwäbisch Hall, 74523 Schwäbisch Hall, Germany; (C.B.); (H.G.)
- Campus Nuremberg-Nord, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, 74523 Schwäbisch Hall, Germany; (C.B.); (H.G.)
- Campus Nuremberg-Nord, Paracelsus Medical University, 90419 Nuremberg, Germany
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Crowe M, Eggleston K, Douglas K, Porter RJ. Effects of psychotherapy on comorbid bipolar disorder and substance use disorder: A systematic review. Bipolar Disord 2021; 23:141-151. [PMID: 32615028 DOI: 10.1111/bdi.12971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This review aim was to examine whether psychotherapy is more or less effective in patients with SUD, compared to those without; whether there is a differential effect of a particular psychotherapy in patients with SUD. METHODS A quantitative systematic review following the Cochrane Handbook of Systematic Reviews was used. RESULTS Five studies of psychotherapy for BD and two studies of an integrated psychotherapy for comorbid BD and SUD were included in the review. Five studies provided a sub-analysis of the effect of SUD on overall outcomes with only one finding an overall detrimental effect. The results indicated equal, if not better outcomes for individuals with comorbid BD and SUD. CONCLUSION There was little evidence that interventions targeted at both BD and SUD may be more efficacious. Further research in to psychotherapeutic treatment for BD should include individuals with comorbid SUD, and analyse substance use as an outcome. Additionally, research into treatments specifically developed for these commonly comorbid disorders is indicated.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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8
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Grunze H, Schaefer M, Scherk H, Born C, Preuss UW. Comorbid Bipolar and Alcohol Use Disorder-A Therapeutic Challenge. Front Psychiatry 2021; 12:660432. [PMID: 33833701 PMCID: PMC8021702 DOI: 10.3389/fpsyt.2021.660432] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023] Open
Abstract
Comorbidity rates in Bipolar disorder rank highest among major mental disorders, especially comorbid substance use. Besides cannabis, alcohol is the most frequent substance of abuse as it is societally accepted and can be purchased and consumed legally. Estimates for lifetime comorbidity of bipolar disorder and alcohol use disorder are substantial and in the range of 40-70%, both for Bipolar I and II disorder, and with male preponderance. Alcohol use disorder and bipolarity significantly influence each other's severity and prognosis with a more complicated course of both disorders. Modern treatment concepts acknowledge the interplay between these disorders using an integrated therapy approach where both disorders are tackled in the same setting by a multi-professional team. Motivational interviewing, cognitive behavioral and socio- therapies incorporating the family and social environment are cornerstones in psychotherapy whereas the accompanying pharmacological treatment aims to reduce craving and to optimize mood stability. Adding valproate to lithium may reduce alcohol consumption whereas studies with antipsychotics or naltrexone and acamprosate did not affect mood fluctuations or drinking patterns. In summary, there is a continuous need for more research in order to develop evidence-based approaches for integrated treatment of this frequent comorbidity.
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Affiliation(s)
- Heinz Grunze
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany
- Paracelsus Medical University Nuremberg, Nuremberg, Germany
- *Correspondence: Heinz Grunze
| | - Martin Schaefer
- Klinik für Psychiatrie, Psychotherapie, Psychosomatik, und Suchtmedizin, Evang. Kliniken Essen-Mitte, Essen, Germany
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christoph Born
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany
- Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ulrich W. Preuss
- Vitos Klinik Psychiatrie und Psychotherapie, Herborn, Germany
- Klinik für Psychiatrie, Psychotherapie, und Psychosomatik, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Hasin D, Walsh C. Cannabis Use, Cannabis Use Disorder, and Comorbid Psychiatric Illness: A Narrative Review. J Clin Med 2020; 10:E15. [PMID: 33374666 PMCID: PMC7793504 DOI: 10.3390/jcm10010015] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 12/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The landscape of attitudes, legal status and patterns of use of cannabis is rapidly changing in the United States and elsewhere. Therefore, the primary aim of this narrative review is to provide a concise overview of the literature on the comorbidity of cannabis use and cannabis use disorder (CUD) with other substance use and psychiatric disorders, and to use this information to accurately guide future directions for the field. METHODS A literature review of PubMed was conducted for studies relating to cannabis use, CUD, and a co-occurring psychiatric disorder. To provide an overview of representative data, the literature review focused on national-level, population-based work from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and National Survey on Drug Use and Health (NSDUH) surveys. Considering rapidly changing cannabis laws, recent (past five-year) studies were addressed. RESULTS A strong body of literature shows associations between cannabis use and CUD with other drug use, psychosis, mood disorders, anxiety disorders, and personality disorders. The strongest evidence of a potential causal relationship exists between cannabis use and psychotic disorders. While some evidence shows potential directionality between cannabis use and mood and anxiety disorders, results are inconsistent. Studies have established higher rates of CUD among those with personality disorders, but little about the specifics of this relationship is understood. CONCLUSIONS Although the general population in the United States increasingly perceives cannabis to be a harmless substance, empirical evidence shows that cannabis use is associated both with CUD and comorbid psychiatric illness. However, there is mixed evidence regarding the role of cannabis in the etiology, course, and prognosis of a co-occurring disorder across all categories of psychiatric disorders. Future research should expand on the existing body of literature with representative, longitudinal data, in order to better understand the acute and long-term effects of cannabis on comorbid psychiatric illness.
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Affiliation(s)
- Deborah Hasin
- New York State Psychiatric Institute, New York, NY 10032, USA;
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Claire Walsh
- New York State Psychiatric Institute, New York, NY 10032, USA;
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10
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Di Florio A, Craddock N, van den Bree M. Alcohol misuse in bipolar disorder. A systematic review and meta-analysis of comorbidity rates. Eur Psychiatry 2020; 29:117-24. [DOI: 10.1016/j.eurpsy.2013.07.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/18/2013] [Accepted: 07/27/2013] [Indexed: 01/24/2023] Open
Abstract
AbstractAims:To assess the comorbidity rates of alcohol use disorders (AUDs) in bipolar disorder (BD) and to explore possible sources of heterogeneity.Methods:Studies were identified through database searches. Meta-analytic techniques were employed to aggregate data on lifetime comorbidity and to explore possible sources of heterogeneity. Funnel plots were used to detect publication bias.Results:In clinical studies, AUDs affected more than one in three subjects with BD. Significant heterogeneity was found, which was largely explained by the geographical location of study populations and gender ratio of participants. AUDs affected more than one in five women and two in five men.Conclusion:AUDs are highly prevalent in BD. Our study revealed a substantial heterogeneity across studies. Further research including control groups is needed. Patients with BD should be assessed for current and previous AUDs.
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Janiri D, Kotzalidis GD, De Chiara L, Koukopoulos AE, Aas M, Sani G. The Ring of Fire: Childhood Trauma, Emotional Reactivity, and Mixed States in Mood Disorders. Psychiatr Clin North Am 2020; 43:69-82. [PMID: 32008689 DOI: 10.1016/j.psc.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Childhood trauma (CT) is strongly associated with bipolar disorder, possibly through emotional hyperreactivity (EH). Mixed symptoms/states (MSs) are associated with increased illness severity. The authors tested through a systematic review the association between CT and MSs. The authors systematically looked for studies exploring associations between MSs and CT, CT and EH, and EH and MSs. Most literature agrees that MSs are associated with CT; the latter was found to be associated to EH, which is in turn associated with MSs. The literature supports an association between CT and later development of MSs, possibly mediated through EH.
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Affiliation(s)
- Delfina Janiri
- Sapienza School of Medicine and Psychology, Sant'Andrea University Hospital, UOC Psichiatria, Via di Grottarossa, 1035-1039, Rome 00189, Italy; ICAHN School of Medicine and Mount Sinai, New York, NY, USA; Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy
| | - Georgios D Kotzalidis
- Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy; School of Medicine and Psychology, NESMOS Department (Neuroscience, Mental Health and Sensory Organs) Sapienza University, Sant'Andrea Hospital, Via di Grottarossa 1035-1038, Rome 00189, Italy.
| | - Lavinia De Chiara
- Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy; School of Medicine and Psychology, NESMOS Department (Neuroscience, Mental Health and Sensory Organs) Sapienza University, Sant'Andrea Hospital, Via di Grottarossa 1035-1038, Rome 00189, Italy
| | - Alexia Emilia Koukopoulos
- Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy; Department of Human Neurosciences, University of Rome "Sapienza", Viale dell'Università 30, Roma 00185, Italy
| | - Monica Aas
- NORMENT K.G Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Bygg 49, Ullevål Sykehus, PO Box 4956, Nydalen, Oslo 0424, Norway
| | - Gabriele Sani
- Institute of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Psychiatry, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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Ibáñez C, Cáceresa J, Brucher R, Seijas D. Trastornos del ánimo y trastornos por uso de sustancias: una comorbilidad compleja y frecuente. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Preuss UW, Hesselbrock MN, Hesselbrock VM. A Prospective Comparison of Bipolar I and II Subjects With and Without Comorbid Alcohol Dependence From the COGA Dataset. Front Psychiatry 2020; 11:522228. [PMID: 33408647 PMCID: PMC7779525 DOI: 10.3389/fpsyt.2020.522228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 10/15/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: Comorbidity of alcohol use disorders in bipolar subjects is high as indicated by epidemiological and clinical studies. Though a more severe course of bipolar disorder in subjects with comorbid alcohol dependence has been reported, fewer studies considered the longitudinal course of alcohol dependence in bipolar subjects and the prospective course of comorbid bipolar II subjects. Beside baseline analysis, longitudinal data of the COGA (Collaborative Study on Genetics in Alcoholism) were used to evaluate the course of bipolar I and II disordered subjects with and without comorbid alcohol dependence over more than 5 years of follow-up. Methods: Characteristics of bipolar disorder, alcohol dependence and comorbid psychiatric disorders were assessed using semi-structured interviews (SSAGA) at baseline and at a 5-year follow-up. Two hundred twenty-eight bipolar I and II patients were subdivided into groups with and without comorbid alcohol dependence. Results: Of the 152 bipolar I and 76 bipolar II patients, 172 (75, 4%) had a comorbid diagnosis of alcohol dependence. Bipolar I patients with alcohol dependence, in particular women, had a more severe course of bipolar disorder, worse social functioning and more suicidal behavior than all other groups of subjects during the 5-year follow-up. In contrast, alcohol dependence improved significantly in both comorbid bipolar I and II individuals during this time. Conclusions: A 5-year prospective evaluation of bipolar patients with and without alcohol dependence confirmed previous investigations suggesting a more severe course of bipolar disorder in comorbid bipolar I individuals, whereas bipolar II individuals were less severely impaired by comorbid alcohol use disorder. While severity of alcohol dependence improved during this time in comorbid alcohol-dependent bipolar I patients, the unfavorable outcome for these individuals might be due to the higher comorbidity with personality and other substance use disorders which, together with alcohol dependence, eventually lead to poorer symptomatic and functional clinical outcomes.
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Affiliation(s)
- Ulrich W Preuss
- Vitos Hospital Psychiatry and Psychotherapy, Herborn, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Martin Luther-University Halle-Wittenberg, Halle, Germany
| | - M N Hesselbrock
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, United States
| | - V M Hesselbrock
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, United States
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14
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Alcohol Consumption and Bipolar Disorder in a Colombian Population Sample. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:44-52. [PMID: 32081208 DOI: 10.1016/j.rcp.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/14/2017] [Accepted: 03/18/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is reported to be the mental disorder with the highest rate of comorbidity with substance use disorders (SUD). More than half of patients with BD have been found to have disorders associated with alcohol use. METHODS A secondary analysis was performed in a population sample of Colombian adults. The aim was to identify bipolar-alcohol comorbidity and factors related to the use of alcohol in people with BD. The diagnosis of BD among participants was made with the "Composite International Diagnostic Interview" (CIDI-CAPI) and the pattern of alcohol consumption in the last year was evaluated with the AUDIT C screening tool. RESULTS It was found that all patients with BD had some type of problematic alcohol consumption pattern. Women with BD were at greater risk of having a dependence-type pattern, using nicotine and marijuana and, among those living in urban areas, had higher rates of suicidal ideation, although that risk was lower if they were in a stable relationship. DISCUSSION Some of the related factors we identified are new with respect to previous publications and others have already been described in similar studies. CONCLUSIONS Given the importance of such factors in the management of this population and their prognosis, these findings highlight the need to determine consumption patterns of alcohol and other substances in patients with BD.
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Xia Y, Ma D, Perich T, Hu J, Mitchell PB. Demographic and Clinical Differences Between Bipolar Disorder Patients With and Without Alcohol Use Disorders. Front Psychiatry 2020; 11:570574. [PMID: 33101085 PMCID: PMC7495181 DOI: 10.3389/fpsyt.2020.570574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) and alcohol use disorder (AUD) are two major independent causes of psychopathology in the general population. The prevalence of AUD in BD is high. Identifying the clinical and demographic features of patients with BD who may develop AUD could help with early identification and intervention. METHODS Data from 238 patients diagnosed with BD were gathered on alcohol use, social demographics, longitudinal course of BD, clinical features of the most severe lifetime manic and depressive episodes, comorbid physical diseases, anxiety disorders, and other substance use disorders. RESULTS We found that 74 of 238 BD patients had AUD (67 with alcohol dependence and 7 with alcohol abuse). Bivariate logistic regression analysis and multivariate logistic regression analysis found that the best predictors of AUD in patients with BD were being male (OR = 2.086, 95% CI = 1.094-3.979, p = 0.001), younger (OR = 0.965, 95% CI = 0.935-0.996, p = 0.026), and comorbidity with other unclassified substance dependence (OR = 10.817, 95% CI = 1.238-94.550, p = 0.031). CONCLUSIONS Male, younger current age, and having other substance use disorders were independently associated with AUD.
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Affiliation(s)
- Yan Xia
- Mental Health Institute, Harbin Medical University, Mental Health Centre, 1st Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongying Ma
- Department of Neurosurgery, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tania Perich
- School of Psychology, Western Sydney University, Sydney, NSW, Australia
| | - Jian Hu
- Mental Health Institute, Harbin Medical University, Mental Health Centre, 1st Affiliated Hospital of Harbin Medical University, Harbin, China
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Prisciandaro JJ, Tolliver BK, DeSantis SM. Identification and initial validation of empirically derived bipolar symptom states from a large longitudinal dataset: an application of hidden Markov modeling to the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study. Psychol Med 2019; 49:1102-1108. [PMID: 30153871 PMCID: PMC7160825 DOI: 10.1017/s0033291718002143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although bipolar disorder (BD) is a fundamentally cyclical illness, a divided model of BD that emphasizes polarity over cyclicity has dominated modern psychiatric diagnostic systems since their advent in the 1980s. However, there has been a gradual return to conceptualizations of BD which focus on longitudinal course in the research community due to emerging supportive data. Advances in longitudinal statistical methods promise to further progress the field. METHODS The current study employed hidden Markov modeling to uncover empirically derived manic and depressive states from longitudinal data [i.e. Young Mania Rating Scale and Montgomery-Asberg Depression Rating Scale responses across five occasions from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study], estimate participants' probabilities of transitioning between these states over time (n = 3918), and evaluate whether clinical variables (e.g. rapid cycling and substance dependence) predict participants' state transitions (n = 3229). RESULTS Analyses identified three empirically derived mood states ('euthymic,' 'depressed,' and 'mixed'). Relative to the euthymic and depressed states, the mixed state was less commonly experienced, more temporally unstable, and uniquely associated with rapid cycling, substance use, and psychosis. Individuals assigned to the mixed state at baseline were relatively less likely to be diagnosed with BD-II (v. BD-I), more likely to present with a mixed or (hypo)manic episode, and reported experiencing irritable and elevated mood more frequently. CONCLUSIONS The results from the current study represent an important step in defining, and characterizing the longitudinal course of, empirically derived mood states that can be used to form the foundation of objective, empirical attempts to define meaningful subtypes of affective illness defined by clinical course.
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Affiliation(s)
- James J. Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of SC, Charleston, SC
| | - Bryan K. Tolliver
- Department of Psychiatry and Behavioral Sciences, Medical University of SC, Charleston, SC
| | - Stacia M. DeSantis
- School of Public Health, University of Texas Health Science Center, Houston, TX
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17
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Tensae DW, Solomon H, Boru B, Getinet W. Prevalence and correlates of alcohol use disorders among bipolar patients at Amanuel Mental Specialized Hospital, Addis Ababa (Ethiopia): A cross-sectional institution based study. J Public Health Afr 2018; 9:829. [PMID: 30854177 PMCID: PMC6379785 DOI: 10.4081/jphia.2018.829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 07/05/2018] [Indexed: 01/21/2023] Open
Abstract
At this time, alcohol use is increasing in African countries. The prevalence of alcohol use disorders (AUDs) remains unknown in patients with psychiatric disorders. This study aimed to assess the prevalence of AUDs among individuals with bipolar disorder in the outpatient department at Amanuel Mental Specialized Hospital. An institution-based cross sectional study was conducted among 412 bipolar patients attending the outpatient department at Amanuel Mental Specialized Hospital from May – July 2015.Participants were selected using a systematic random sampling technique. Semi-structured questionnaires were used to collect socio-demographic and clinical data. Alcohol use disorder was measured using the Alcohol Use Disorders Identification Test (AUDIT-10). Binary logistic regression analysis was performed. The prevalence of alcohol use disorder was found to be 24.5%. Those affected were predominantly female (58.5%). Being18-29 years of age(AOR=3.86, 95% CI: 1.34, 11.29), being 30-44 years of age (AOR=4.99, 95%CI: 1.85, 13.46), being unable to read and write (AOR=5.58, 95%CI: 2.026, 13.650), having a secondary education (AOR=3.198, 95%CI: 1.149, 8.906), being a farmer (AOR=4.54, 95%CI: 1.67, 12.32), being employed by the government (AOR=3.53, 95%CI: 1.36, 4.15), being a day labourer (AOR=3.5, 95%CI: 1.14, 10.77), use of other substances during past 12 months (AOR=2.06, 95%CI: 1.06, 3.99), having a family history of alcohol use (AOR=2.18, 95%CI: 1.29, 3.68), having discontinued medication (AOR=2.78, 95%CI: 1.52, 5.07), having suicidal thoughts (AOR=4.56, 95%CI: 2.43, 8.54), and having attempted suicide (AOR=5.67, 95%CI: 3.27, 9.81) were statistically significant to alcohol use disorder using multivariate logistic analysis. The prevalence of co-morbid alcohol use disorder was high. This finding suggests that screening for risky alcohol use should be integrated into routine hospital outpatient care. Further, preventive measures against alcohol use disorder should be established.
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Affiliation(s)
| | | | - Berhanu Boru
- Department of Nursing, College of Medicine and Health Sciences, University of Gondar
| | - Wondale Getinet
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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18
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Stump TA, Eng ML. The development and psychometric properties of the bipolar disorders knowledge scale. J Affect Disord 2018; 238:645-650. [PMID: 29957482 DOI: 10.1016/j.jad.2018.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/23/2018] [Accepted: 05/27/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Bipolar Disorder (BD) presents in 1-4% of the world's population, carrying significant financial and functional consequences. Beyond the direct disease burden, patients with BD experience a high degree of both internal and external stigma. Additionally, medication adherence tends to be poor in patients with BD. Knowledge appears to play a role in mitigating both stigma and non-adherence, but these relationships have not been fully elucidated. The Bipolar Disorder Knowledge Scale (BDKS) was designed to explore the role of knowledge and better define such relationships. This research provides the evidence for the reliability and validity of the scale. METHODS Forty-seven items were developed to assess knowledge of BD. The 47-item survey was sent out to two groups: first a group of 43 pharmacists with BCPP credentials from the College of Psychiatric and Neurologic Pharmacists (CPNP) who were recruited from the CPNP directory, and second a group of 250 members of the general public who were recruited using Qualtrics Online Sample service. Participants were surveyed on their education status, health literacy, BD diagnostic status, and exposure to patients with BD. Participants then completed the 47-item scale. After 48 h 100 members from the original general public group were sent the same survey to assess test-retest reliability. For each item a difficulty index to evaluate how well participants performed on the item and a discrimination index to determine how well each item performed in high-scorers versus low scorers were calculated. Additionally, Cronbach's alpha was calculated to determine internal consistency validity and a Pearson correlation was run to determine test-retest reliability. Items were removed based on the results from the difficulty index, discrimination index, and Cronbach's alpha. Finally the pharmacist final scores were compared to the general public using an unpaired t-test to assess whether content experts were more likely to perform better on the scale. Following item removal, the scale was finalized at 25-items. RESULTS The mean score for the scale was 34.48 (71.83%; SD: 5.50) and the Cronbach's alpha was 0.773 before item analysis. Following item analysis, 22 items were dropped leaving 25 items on the final version of the scale. The remaining items retained a difficulty index below 90% and a discrimination index above 20%. The mean of the 25-item scale was 18.40 (73.6%; SD: 4.13) for the general public and 23.20 (92.8%; SD: 1.36) for the pharmacists group (p < 0.001). The Cronbach's alpha for the finalized scale was 0.760, indicating a high-degree of internal consistency. While this is lower than the original alpha, this may be explained by the reduced number of scale items. A 25-item scale is much more practical and the items on the scale retain stronger item analysis statistics. Finally, the Pearson Correlation for the group who underwent the test-retest procedure was 0.841 (p < 0.001) indicating strong test-retest reliability. CONCLUSION The BDKS is a 25-item true-false scale that takes approximately 5-10 min to complete. The scale assesses knowledge of BD with items targeting diagnosis, etiology, disease course, symptoms, treatment, and life impact. The scale has shown strong internal consistency and test-retest reliability in a general population and will be useful for evaluating knowledge of BD as it relates to stigma, non-adherence, and other variables.
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Affiliation(s)
- Trevor A Stump
- Department of Pharmacy, Summa Health, Akron, OH, United States
| | - Marty L Eng
- School of Pharmacy, Cedarville University, 251 N. Main Street, Cedarville.45314, OH, United States.
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Jones S, Riste L, Barrowclough C, Bartlett P, Clements C, Davies L, Holland F, Kapur N, Lobban F, Long R, Morriss R, Peters S, Roberts C, Camacho E, Gregg L, Ntais D. Reducing relapse and suicide in bipolar disorder: practical clinical approaches to identifying risk, reducing harm and engaging service users in planning and delivery of care – the PARADES (Psychoeducation, Anxiety, Relapse, Advance Directive Evaluation and Suicidality) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery after inadequate treatment.ObjectivesA programme of linked studies to reduce relapse and suicide in BD.DesignThere were five workstreams (WSs): a pragmatic randomised controlled trial (RCT) of group psychoeducation (PEd) versus group peer support (PS) in the maintenance of BD (WS1); development and feasibility RCTs of integrated psychological therapy for anxiety in bipolar disorder (AIBD) and integrated for problematic alcohol use in BD (WS2 and WS3); survey and qualitative investigations of suicide and self-harm in BD (WS4); and survey and qualitative investigation of service users’ (SUs) and psychiatrists’ experience of the Mental Capacity Act 2005 (MCA), with reference to advance planning (WS5).SettingParticipants were from England; recruitment into RCTs was limited to certain sites [East Midlands and North West (WS1); North West (WS2 and WS3)].ParticipantsAged ≥ 18 years. In WS1–3, participants had their diagnosis of BD confirmed by the Structural Clinical Interview for theDiagnostic and Statistical Manual of Mental Disorders.InterventionsIn WS1, group PEd/PS; in WS3 and WS4, individual psychological therapy for comorbid anxiety and alcohol use, respectively.Main outcome measuresIn WS1, time to relapse of bipolar episode; in WS2 and WS3, feasibility and acceptability of interventions; in WS4, prevalence and determinants of suicide and self-harm; and in WS5, professional training and support of advance planning in MCA, and SU awareness and implementation.ResultsGroup PEd and PS could be routinely delivered in the NHS. The estimated median time to first bipolar relapse was 67.1 [95% confidence interval (CI) 37.3 to 90.9] weeks in PEd, compared with 48.0 (95% CI 30.6 to 65.9) weeks in PS. The adjusted hazard ratio was 0.83 (95% CI 0.62 to 1.11; likelihood ratio testp = 0.217). The interaction between the number of previous bipolar episodes (1–7 and 8–19, relative to 20+) and treatment arm was significant (χ2 = 6.80, degrees of freedom = 2;p = 0.034): PEd with one to seven episodes showed the greatest delay in time to episode. A primary economic analysis indicates that PEd is not cost-effective compared with PS. A sensitivity analysis suggests potential cost-effectiveness if decision-makers accept a cost of £37,500 per quality-adjusted life-year. AIBD and motivational interviewing (MI) cognitive–behavioural therapy (CBT) trials were feasible and acceptable in achieving recruitment and retention targets (AIBD:n = 72, 72% retention to follow-up; MI-CBT:n = 44, 75% retention) and in-depth qualitative interviews. There were no significant differences in clinical outcomes for either trial overall. The factors associated with risk of suicide and self-harm (longer duration of illness, large number of periods of inpatient care, and problems establishing diagnosis) could inform improved clinical care and specific interventions. Qualitative interviews suggested that suicide risk had been underestimated, that care needs to be more collaborative and that people need fast access to good-quality care. Despite SUs supporting advance planning and psychiatrists being trained in MCA, the use of MCA planning provisions was low, with confusion over informal and legally binding plans.LimitationsInferences for routine clinical practice from WS1 were limited by the absence of a ‘treatment as usual’ group.ConclusionThe programme has contributed significantly to understanding how to improve outcomes in BD. Group PEd is being implemented in the NHS influenced by SU support.Future workFuture work is needed to evaluate optimal approaches to psychological treatment of comorbidity in BD. In addition, work in improved risk detection in relation to suicide and self-harm in clinical services and improved training in MCA are indicated.Trial registrationCurrent Controlled Trials ISRCTN62761948, ISRCTN84288072 and ISRCTN14774583.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steven Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lisa Riste
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Peter Bartlett
- School of Law and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Caroline Clements
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Fiona Holland
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Nav Kapur
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Manchester Mental Health & Social Care NHS Trust, Manchester, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Rita Long
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Chris Roberts
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Lynsey Gregg
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Institute of Population Health, University of Manchester, Manchester, UK
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Gold AK, Peters AT, Otto MW, Sylvia LG, Magalhaes PVDS, Berk M, Dougherty DD, Miklowitz DJ, Frank E, Nierenberg AA, Deckersbach T. The impact of substance use disorders on recovery from bipolar depression: Results from the Systematic Treatment Enhancement Program for Bipolar Disorder psychosocial treatment trial. Aust N Z J Psychiatry 2018; 52:847-855. [PMID: 30047784 PMCID: PMC6778400 DOI: 10.1177/0004867418788172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Up to 60% of patients with bipolar disorder develop a substance use disorder during their lifetime. The purpose of this paper was to assess the impact of substance use disorders on depression recovery among bipolar patients randomly assigned to different psychotropic medications and psychosocial interventions. We hypothesized that patients with a comorbid substance use disorder would benefit less from psychotherapy regardless of treatment intensity/length compared to patients without a comorbid substance use disorder. METHOD We conducted post hoc analyses among bipolar disorder patients ( n = 270) with and without comorbid substance use disorders enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder randomized psychosocial intervention trial. All patients entered during or shortly after the onset of a bipolar depressive episode. Logistic regression and Cox proportional hazard models were used to assess whether current or past substance use disorders moderated the response of patients to intensive psychosocial intervention or brief psychoeducation with collaborative care, operationalized as full recovery from an episode of bipolar depression. RESULTS Current comorbid substance use disorders significantly predicted likelihood of recovery (odds ratio = 2.25, p = 0.025) and time to recovery (odds ratio = 1.71, p = 0.006) from bipolar depression. We found that 74.5% of patients with a current substance use disorder, compared to 56.5% without a current substance use disorder, recovered from bipolar depression. Past substance use disorders did not predict likelihood of recovery or time to recovery. Current substance use disorders did not significantly moderate response to intensive psychotherapy versus collaborative care. CONCLUSION Contrary to our hypotheses, bipolar disorder participants with a current comorbid substance use disorder were more likely to recover from psychosocial treatment for bipolar depression than patients without a current comorbid substance use disorder. If this finding is replicated, it has implications for the ordering of treatment for patients with comorbid bipolar disorder and substance use disorders.
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Affiliation(s)
- Alexandra K Gold
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Amy T Peters
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael W Otto
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Michael Berk
- Impact Strategic Research Centre, Deakin University, Melbourne, VIC, Australia,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - David J Miklowitz
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ellen Frank
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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21
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Titone MK, Freed RD, O'Garro-Moore JK, Gepty A, Ng TH, Stange JP, Abramson LY, Alloy LB. The role of lifetime anxiety history in the course of bipolar spectrum disorders. Psychiatry Res 2018; 264:202-209. [PMID: 29653349 PMCID: PMC5972058 DOI: 10.1016/j.psychres.2018.03.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/13/2018] [Accepted: 03/31/2018] [Indexed: 12/20/2022]
Abstract
Individuals with bipolar spectrum disorder (BSD) frequently meet criteria for comorbid anxiety disorders, and anxiety may be an important factor in the etiology and course of BSDs. The current study examined the association of lifetime anxiety disorders with prospective manic/hypomanic versus major depressive episodes. Participants were 244 young adults (aged 17-26) with milder forms of BSDs (i.e., bipolar-II, cyclothymia, BD-NOS). First, bivariate analyses assessed differences in baseline clinical characteristics between participants with and without DSM-IV anxiety diagnoses. Second, negative binomial regression analyses tested whether lifetime anxiety predicted number of manic/hypomanic or major depressive episodes developed during the study. Third, survival analyses evaluated whether lifetime anxiety predicted time to onset of manic/hypomanic and major depressive episodes. Results indicated that anxiety history was associated with greater illness severity at baseline. Over follow-up, anxiety history predicted fewer manic/hypomanic episodes, but did not predict number of major depressive episodes. Anxiety history also was associated with longer time to onset of manic/hypomanic episodes, but shorter time to onset of depressive episodes. Findings corroborate past studies implicating anxiety disorders as salient influences on the course of BSDs. Moreover, results extend prior research by indicating that anxiety disorders may be linked with reduced manic/hypomanic phases of illness.
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Affiliation(s)
- Madison K Titone
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Rachel D Freed
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Jared K O'Garro-Moore
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Andrew Gepty
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Tommy H Ng
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Jonathan P Stange
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison, 1202W. Johnson Street, Madison, WI 53706, USA
| | - Lauren B Alloy
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA.
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22
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Prossin AR, Chandler M, Ryan KA, Saunders EF, Kamali M, Papadopoulos V, Zöllner S, Dantzer R, McInnis MG. Functional TSPO polymorphism predicts variance in the diurnal cortisol rhythm in bipolar disorder. Psychoneuroendocrinology 2018; 89:194-202. [PMID: 29414032 PMCID: PMC6048960 DOI: 10.1016/j.psyneuen.2018.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Psychosocial stress contributes to onset/exacerbation of mood episodes and alcohol use, suggesting dysregulated diurnal cortisol rhythms underlie episodic exacerbations in Bipolar Disorder (BD). However, mechanisms underlying dysregulated HPA rhythms in BD and alcohol use disorders (AUD) are understudied. Knowledge of associated variance factors have great clinical translational potential by facilitating development of strategies to reduce stress-related relapse in BD and AUD. Evidence suggests structural changes to mitochondrial translocator protein (TSPO) (a regulator of steroid synthesis) due to the single nucleotide polymorphism rs6971, may explain much of this variance. However, whether rs6971 is associated with abnormal HPA rhythms and clinical exacerbation in humans is unknown. METHODS To show this common TSPO polymorphism impacts HPA rhythms in BD, we tested whether rs6971 (dichotomized: presence/absence of polymorphism) predicted variance in diurnal cortisol rhythm (saliva: morning and evening for 3 days) in 107 BD (50 with and 57 without AUD) and 28 healthy volunteers of similar age and ethno-demographic distribution. RESULTS Repeated measures ANOVA confirmed effects BD (F5,525 = 3.0, p = 0.010) and AUD (F5,525 = 2.9, p = 0.012), but not TSPO polymorphism (p > 0.05). Interactions were confirmed for TSPO × BD (F5,525 = 3.9, p = 0.002) and for TSPO × AUD (F5,525 = 2.8, p = 0.017). DISCUSSION We identified differences in diurnal cortisol rhythm depending on presence/absence of common TSPO polymorphism in BD volunteers with or without AUD and healthy volunteers. These results have wide ranging implications but further validation is needed prior to optimal clinical translation.
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Affiliation(s)
- Alan R Prossin
- Department of Psychiatry, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA; Houston Methodist Research Institute, Houston, TX, USA.
| | - Matthew Chandler
- Department of Psychiatry, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kelly A Ryan
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Erika F Saunders
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Psychiatry, Medical School, Penn State College of Medicine and the Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Masoud Kamali
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Sebastian Zöllner
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robert Dantzer
- Department of Symptom Research, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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23
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McInnis MG, Assari S, Kamali M, Ryan K, Langenecker SA, Saunders EFH, Versha K, Evans S, O’Shea KS, Mower Provost E, Marshall D, Forger D, Deldin P, Zoellner S. Cohort Profile: The Heinz C. Prechter Longitudinal Study of Bipolar Disorder. Int J Epidemiol 2018; 47:28-28n. [PMID: 29211851 PMCID: PMC5837550 DOI: 10.1093/ije/dyx229] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Masoud Kamali
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kelly Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Scott A Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Erika FH Saunders
- Department of Psychiatry, Penn State Hershey Medical Group, Hershey, PA, USA
| | - Kritika Versha
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Simon Evans
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - K Sue O’Shea
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Cell and Developmental Biology
| | | | - David Marshall
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Sebastian Zoellner
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
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24
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McEvedy SM, Furness T, McKenna B. Introduction of a drug-detection dog programme in mental health inpatient units: A mixed-methods study of consumer, staff, and carers' perceptions. Int J Ment Health Nurs 2018; 27:408-421. [PMID: 28589658 DOI: 10.1111/inm.12335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2017] [Indexed: 11/30/2022]
Abstract
Many consumers admitted to mental health inpatient units also use illicit drugs, and some continue to do so while receiving treatment. In an attempt to curb the impact of illicit drug use, one of Australia's largest mental health services introduced a programme of drug-detection dog (DDD) searches. Our aim was to evaluate perceptions of the DDD programme among mental health consumers, staff, and carers. A mixed-methods research design using a concurrent triangulation approach was adopted, involving three focus group discussions with consumer, staff, and carer groups, and a structured survey among 94 consumers who were receiving treatment and 102 staff working in the units at the time of a DDD visit. Data were analysed using thematic analysis, and descriptive and inferential statistics. Major themes were that: (i) drug use in these units is perceived as 'prevalent' and 'destructive'; (ii) the DDD programme is 'beneficial' but 'incongruous' in a health-care setting; (iii) consumers are 'uninformed'; and (iv) consequences should be 'customized' to circumstances. Survey results corroborated qualitative themes, with the exception that although concerns about incongruity do exist, they were not prevalent and were outweighed by positive perceptions of the programme. Most perceptions were consistent between consumers and staff. However, consumers tended to think that, if found, drugs should be confiscated, whereas staff were more strongly in favour of the consumer being discharged. In conclusion, the DDD programme was seen as a positive step towards addressing drug use in mental health units. However, improved dissemination of information to consumers through verbal and written communication is required.
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Affiliation(s)
- Samantha M McEvedy
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,NorthWestern Mental Health, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Brian McKenna
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.,Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand
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25
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Bobo WV. The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update. Mayo Clin Proc 2017; 92:1532-1551. [PMID: 28888714 DOI: 10.1016/j.mayocp.2017.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 12/21/2022]
Abstract
Bipolar disorders, including bipolar I disorder (BP-I) and bipolar II disorder (BP-II), are common, potentially disabling, and, in some cases, life-threatening conditions. Bipolar disorders are characterized by alternating episodes of mania or hypomania and depression, or mixtures of manic and depressive features. Bipolar disorders present many diagnostic and therapeutic challenges for busy clinicians. Adequate management of bipolar disorders requires pharmacotherapy and psychosocial interventions targeted to the specific phases of illness. Effective treatments are available for each illness phase, but mood episode relapses and incomplete responses to treatment are common, especially for the depressive phase. Mood symptoms, psychosocial functioning, and suicide risk must, therefore, be continually reevaluated, and, when necessary, the plan of care must be adjusted during long-term treatment. Many patients will require additional treatment of comorbid psychiatric and substance use disorders and management of a variety of commonly co-occurring chronic general medical conditions.
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Affiliation(s)
- William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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26
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Subramanian K, Sarkar S, Kattimani S. Bipolar disorder in Asia: Illness course and contributing factors. Asian J Psychiatr 2017; 29:16-29. [PMID: 29061417 DOI: 10.1016/j.ajp.2017.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/15/2017] [Accepted: 04/16/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Epidemiological studies analysing the course of Bipolar Disorder (BD) are relatively rare in the Asian context, contributing to the uncertainty regarding the prevalent course patterns and factors influencing such patterns. The current review identifies the regional characteristics of BD course patterns and the associated factors. METHODS A review of the existing literature was done using 'PubMed' and 'Cochrane' databases which yielded 145 studies including those from all 48 Asian countries. Relevant discussions from the Western literature were incorporated. RESULTS Regional and cross-national studies reveal a mania-predominant course in BD in Asian countries. Prolonged depressive episodes and comorbid anxiety disorders worsen the course of BD-II. Certain risk factors such as the young age of onset and greater episode frequency are useful predictors of bipolar diatheses. Substance use disorder comorbidity is more prevalent in males whereas depression and suicidal behaviours are more frequent in females with BD. Comorbid anxiety and personality disorders also encumber the illness course. Logistic reasons and ignorance of side-effects were specifically associated with poor adherence. An 'eveningness' chronotype and poor sleep quality were associated with frequent recurrences. Seasonal patterns vary among men and women, especially for depressive episodes. LIMITATIONS The effects of treatment and childhood BD course features were not discussed. CONCLUSIONS There are region-specific characteristics in bipolar illness course and factors influencing such course patterns compared to the rest of the World. Future research from Asia shall attempt to study the neurobiological underpinnings of such characteristics and plan appropriate strategies to address the same.
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Affiliation(s)
- Karthick Subramanian
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
| | - Siddharth Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
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27
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Gao K, Ganocy SJ, Conroy C, Brownrigg B, Serrano MB, Calabrese JR. A placebo controlled study of quetiapine-XR in bipolar depression accompanied by generalized anxiety with and without a recent history of alcohol and cannabis use. Psychopharmacology (Berl) 2017; 234:2233-2244. [PMID: 28536866 DOI: 10.1007/s00213-017-4642-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/25/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to compare treatment response in bipolar I or II depression and generalized anxiety disorder (GAD) with and without recent alcohol and/or cannabis use disorder (ALC/CAN) to quetiapine-XR (extended release) or placebo. METHODS A randomized, double-blind, 8-week study of quetiapine-XR versus placebo in patients with bipolar I or II depression and GAD with or without a recent ALC/CAN was used to compare changes in Hamilton Depression Rating Scale-17, Hamilton Anxiety Rating Scale, the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR-16), Clinical Global Impression for Bipolar Disorder-Severity (CGI-BP-S), and Timeline Follow Back within and between groups. RESULTS In the quetiapine-XR group, patients with a recent ALC/CAN (n = 22) had significant decreases in QIDS-SR-16 (-9.6 ± 1.6 vs. -3.7 ± 1.7) and CGI-BP-S (-1.6 ± 0.4 vs. -0.8 ± 0.03) than those without a recent ALC/CAN (n = 24). In the placebo group, both patients with a recent ALC/CAN (n = 23) and those without (n = 21) had similar reductions in these measures. The reduction of QIDS-SR-16 scores in patients with a recent ALC/CAN was also significantly different from that of their counterparts in the placebo group. Patients who received quetiapine-XR had larger decreases in the number of drinking days/week (p = 0.17) and number of cannabis joints/week (p = 0.09) compared to those who received placebo. CONCLUSION Quetiapine-XR was superior to placebo in reducing QIDS-SR-16 total score in patients with a recent ALC/CAN. Patients taking quetiapine-XR used less alcohol and cannabis than patients on placebo, suggesting that quetiapine-XR may be of use in patients with bipolar disorder accompanied by GAD and other comorbidities.
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Affiliation(s)
- Keming Gao
- Mood and Anxiety Clinic in the Mood Disorders Program, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, 10524 Euclid Avenue, 12th Floor, Cleveland, OH, 44106, USA.
| | - Stephen J Ganocy
- Mood and Anxiety Clinic in the Mood Disorders Program, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, 10524 Euclid Avenue, 12th Floor, Cleveland, OH, 44106, USA
| | - Carla Conroy
- Mood and Anxiety Clinic in the Mood Disorders Program, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, 10524 Euclid Avenue, 12th Floor, Cleveland, OH, 44106, USA
| | - Brittany Brownrigg
- Mood and Anxiety Clinic in the Mood Disorders Program, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, 10524 Euclid Avenue, 12th Floor, Cleveland, OH, 44106, USA
| | - Mary Beth Serrano
- Mood and Anxiety Clinic in the Mood Disorders Program, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, 10524 Euclid Avenue, 12th Floor, Cleveland, OH, 44106, USA
| | - Joseph R Calabrese
- Mood and Anxiety Clinic in the Mood Disorders Program, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, 10524 Euclid Avenue, 12th Floor, Cleveland, OH, 44106, USA
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28
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Messer T, Lammers G, Müller-Siecheneder F, Schmidt RF, Latifi S. Substance abuse in patients with bipolar disorder: A systematic review and meta-analysis. Psychiatry Res 2017; 253:338-350. [PMID: 28419959 DOI: 10.1016/j.psychres.2017.02.067] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/11/2017] [Accepted: 02/12/2017] [Indexed: 12/25/2022]
Abstract
By considering the debilitating outcome of co-occurring of bipolar disorder (BD) and substance abuse, determination of risk factors of substance use disorders (SUD: abuse or dependence of drugs and/or alcohol) is essential to identify the susceptible patients. The purpose of this study was to clarify the major determinant factors of SUD among adults with BD by reviewing the relevant literature. We systematically searched electronic databases including PubMed (MEDLINE), EMBASE, OVID, Cochrane and Scopus for human studies addressing the co-existence of bipolar disorder and SUD. All potential published papers up to September 2016 have been reviewed. The statistical analysis was performed using Comprehensive Meta-analysis version 2. Male gender (Odds ratio: 2.191 (95% CI: 1.121-4.281), P 0.022), number of manic episodes (P: 0.001) and previous history of suicidality (Odds ratio: 1.758 (95% CI: 1.156-2.674), P: 0.008) were associated to SUD in patients with BD. SUD was not related to age, subtype of BD, hospitalization and co-existence of anxiety disorders or psychotic symptoms. SUD affects many aspects of BD regarding clinical course, psychopathology and prognosis. Our study demonstrates that male gender, history of higher number of manic episodes and suicidality are associated to higher susceptibility to SUD. Thus, assignment of more intensive therapeutic interventions should be considered in patients with increased risk of drug abuse to prevent development of SUD.
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Affiliation(s)
- Thomas Messer
- Danuvius Klinik GmbH, Pfaffenhofen an der Ilm, Technischen Universität München, Bavaria, Germany
| | - Gero Lammers
- Danuvius Klinik GmbH, Pfaffenhofen an der Ilm, Technischen Universität München, Bavaria, Germany
| | | | - Raluca-Florela Schmidt
- Danuvius Klinik GmbH, Pfaffenhofen an der Ilm, Technischen Universität München, Bavaria, Germany
| | - Sahar Latifi
- Danuvius Klinik GmbH, Pfaffenhofen an der Ilm, Technischen Universität München, Bavaria, Germany.
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29
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Berk L, Hallam KT, Venugopal K, Lewis AJ, Austin DW, Kulkarni J, Dodd S, de Castella A, Fitzgerald PB, Berk M. Impact of irritability: a 2-year observational study of outpatients with bipolar I or schizoaffective disorder. Bipolar Disord 2017; 19:184-197. [PMID: 28470892 DOI: 10.1111/bdi.12486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/12/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Many people experience irritability when manic, hypomanic, or depressed, yet its impact on illness severity and quality of life in bipolar and schizoaffective disorders is poorly understood. This study aimed to examine the relationship between irritability and symptom burden, functioning, quality of life, social support, suicidality, and overall illness severity in a naturalistic cohort of people with bipolar I or schizoaffective disorder. METHODS We used data from 239 adult outpatients with bipolar I or schizoaffective disorder in the Bipolar Comprehensive Outcomes Study (BCOS) - a non-interventional observational study with a 2-year follow-up period. Baseline demographic and clinical characteristics of participants with and without irritability were compared. A mixed-model repeated measures analysis was conducted to examine the longitudinal effect of irritability on clinical and quality-of-life variables over follow-up using significant baseline variables. RESULTS At baseline, 54% of participants were irritable. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not diagnosis (schizoaffective/bipolar disorder). Participants with irritability were less likely to have a partner and perceived less adequate social support. On average, over follow-up, those with irritability reported more symptoms, functional impairment, and suicidality. Furthermore, the effects of irritability could not be fully explained by illness severity. CONCLUSIONS Irritability was associated with more negative symptomatic, functional, and quality-of-life outcomes and suicidality. The identification, monitoring, and targeted treatment of irritability may be worth considering, to enhance health and wellbeing outcomes for adults with bipolar and schizoaffective disorders.
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Affiliation(s)
- Lesley Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia.,Melbourne School of Global and Population Health, University of Melbourne, Parkville, Vic., Australia
| | - Karen T Hallam
- Department of Psychology, The University of Melbourne, Parkville, Vic., Australia.,Department of Psychology, Victoria University, Melbourne, Vic., Australia
| | - Kamalesh Venugopal
- South Australian Department for Health and Ageing, Adelaide, SA, Australia
| | - Andrew James Lewis
- School of Psychology & Exercise Science, Murdoch University, Murdoch, WA, Australia.,Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - David W Austin
- School of Psychology, Faculty of Health, Deakin University, Burwood, Vic., Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, Vic., Australia
| | - Seetal Dodd
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia
| | - Anthony de Castella
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, Vic., Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, Vic., Australia
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, Vic., Australia
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30
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Pary R, Patel M, Lippmann S. Depression and Bipolar Disorders in Patients With Alcohol Use Disorders. Fed Pract 2017; 34:37S-41S. [PMID: 30766306 PMCID: PMC6375498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This review details methods for meeting the challenges of diagnosing and treating mood disorders that coexist with substance use disorders.
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Affiliation(s)
- Raymond Pary
- is a psychiatrist at Louisville VAMC in Kentucky. is a psychiatry resident, is a professor, and Dr. Pary is an associate professor, all at the University of Louisville, Kentucky
| | - Mitesh Patel
- is a psychiatrist at Louisville VAMC in Kentucky. is a psychiatry resident, is a professor, and Dr. Pary is an associate professor, all at the University of Louisville, Kentucky
| | - Steven Lippmann
- is a psychiatrist at Louisville VAMC in Kentucky. is a psychiatry resident, is a professor, and Dr. Pary is an associate professor, all at the University of Louisville, Kentucky
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Kvitland LR, Ringen PA, Aminoff SR, Demmo C, Hellvin T, Lagerberg TV, Andreassen OA, Melle I. Duration of untreated illness in first-treatment bipolar I disorder in relation to clinical outcome and cannabis use. Psychiatry Res 2016; 246:762-768. [PMID: 27814886 DOI: 10.1016/j.psychres.2016.07.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/24/2016] [Accepted: 07/10/2016] [Indexed: 12/22/2022]
Abstract
There is little knowledge about the role of the duration of untreated bipolar (DUB) illness in first-treatment bipolar disorder I (BD I), its association with symptoms at start of first treatment, and development over the first year, and limited knowledge about factors that influence the length of DUB. Substance use has shown to delay identification of primary psychiatric disorders, and while cannabis use is common in BD the role of cannabis in relationship to DUB is unclear. The aim of the present study is to examine the associations between DUB and key clinical outcomes at baseline in BD I, and at one year follow-up, and to evaluate the influence of cannabis use. Patients with first-treatment BD I (N=62) completed comprehensive clinical evaluations, which included both DUB and the number of previous episodes. There were no significant associations between DUB and key clinical outcomes. Longer duration from first manic episode to treatment was associated with risk of starting excessive cannabis use after onset of the bipolar disorder. The main finding is the lack of significant associations between features of previous illness episodes and clinical outcomes. Long duration of untreated mania seems to increase the risk for later cannabis use.
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Affiliation(s)
- Levi Røstad Kvitland
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | | | - Sofie Ragnhild Aminoff
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway; Division of Mental Health Services, Department of Specialized Inpatient Treatment, Akershus University Hospital, Akershus, Norway.
| | - Christine Demmo
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Tone Hellvin
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Trine Vik Lagerberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Ole Andreas Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
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Hunt GE, Malhi GS, Cleary M, Lai HMX, Sitharthan T. Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990-2015: Systematic review and meta-analysis. J Affect Disord 2016; 206:331-349. [PMID: 27476137 DOI: 10.1016/j.jad.2016.07.011] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/09/2016] [Accepted: 07/03/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Comorbidity between substance use disorders (SUDs) and bipolar disorder (BD) is highly prevalent to the extent it may almost be regarded the norm. This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in treatment seeking patients diagnosed with BD in both inpatient and outpatient settings. METHODS A comprehensive literature search of Medline, EMBASE, psychINFO and CINAHL databases was conducted from 1990 to 2015. Prevalence of co-morbid SUDs and BD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis. RESULTS There were 151 articles identified by electronic searches that yielded 22 large, multi-site studies and 56 individual studies describing comorbid rates of SUDs amongst community dwelling, BD inpatients or outpatients. The SUDs with the highest prevalence in BD were alcohol use (42%) followed by cannabis use (20%) and other illicit drug use (17%). Meta-analysis showed males had higher lifetime risks of SUDs compared to females. BD and comorbid SUDS were associated with earlier age of onset and slightly more hospitalisations than non-users. LIMITATIONS The results do not take into account the possibility that individuals may have more than one comorbid disorder, such as having more than one SUD, anxiety disorder, or other combination. Some of the meta-analyses were based on relatively few studies with high rates of heterogeneity. Most included studies were cross-sectional and therefore causality cannot be inferred. CONCLUSIONS This systematic review shows comorbidity between SUDs and bipolar illness is highly prevalent in hospital and community-based samples. The prevalence of SUDs was similar in patients with bipolar I and bipolar II disorders. This study adds to the literature demonstrating that SUDs are common in BD and reinforces the need to provide better interventions and properly conducted treatment trials to reduce the burden conferred by comorbid SUD and BD.
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Affiliation(s)
- Glenn E Hunt
- Discipline of Psychiatry, University of Sydney, NSW, Australia.
| | - Gin S Malhi
- Discipline of Psychiatry and CADE Clinic, Royal North Shore Hospital, University of Sydney, NSW, Australia.
| | - Michelle Cleary
- School of Health Sciences, University of Tasmania, Sydney, NSW, Australia.
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Lozano ÓM, Rojas AJ, Fernández Calderón F. Psychiatric comorbidity and severity of dependence on substance users: how it impacts on their health-related quality of life? J Ment Health 2016; 26:119-126. [PMID: 27128492 DOI: 10.1080/09638237.2016.1177771] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the impact of psychiatric comorbidity and severity of dependence on health-related quality of life (HRQoL). METHODS One hundred and ninety-eight substance use disorder (SUD) patients were recruited from an outpatient center that provides treatment for SUD. The International Personality Disorder Examination Screening Questionnaire (IPDE-SQ), Mini International Neuropsychiatric Interview (MINI), Substance Dependence Severity Scale (SDSS) and Health-Related Quality of Life for Drug Abusers test (HRQoLDA test) were administered. RESULTS Patients with psychiatric comorbidity evaluated their HRQoL more negatively than patients without psychiatric comorbidity. An analysis of the relationship between severity of dependence and HRQoL scores indicated significant correlations among alcohol-, cocaine-, heroin- and cannabis-dependent patients. According to multivariate analyses, anxiety disorders, mood disorders, severity of dependence on alcohol, cannabis, cocaine, paranoid, borderline and avoidant personality disorders (PDs) were observed to have a major impact on HRQoL. CONCLUSIONS SUD (severity of dependence on alcohol, cannabis and cocaine) and other mental disorders (anxiety disorders; mood disorders; paranoid, borderline and avoidant PDs) are involved in the deterioration of the SUD patients' HRQoL. This study demonstrates the need for integrated treatment for SUD patients. Treating only a part of the problem (whether SUD or other mental disorders are present) is insufficient for improving quality of life.
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Affiliation(s)
- Óscar M Lozano
- a Department of Social , Experimental and Clinical Psychology, University of Huelva , Avda. Fuerzas Armadas, Huelva , Spain and
| | - Antonio J Rojas
- b Department of Psychology , University of Almería , La Cañada de San Urbano, Almería , Spain
| | - Fermín Fernández Calderón
- a Department of Social , Experimental and Clinical Psychology, University of Huelva , Avda. Fuerzas Armadas, Huelva , Spain and
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Tolliver BK, Anton RF. Assessment and treatment of mood disorders in the context of substance abuse. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26246792 PMCID: PMC4518701 DOI: 10.31887/dcns.2015.17.2/btolliver] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recognition and management of mood symptoms in individuals using alcohol and/or other drugs represent a daily challenge for clinicians in both inpatient and outpatient treatment settings. Diagnosis of underlying mood disorders in the context of ongoing substance abuse requires careful collection of psychiatric history, and is often critical for optimal treatment planning and outcomes. Failure to recognize major depression or bipolar disorders in these patients can result in increased relapse rates, recurrence of mood episodes, and elevated risk of completed suicide. Over the past decade, epidemiologic research has clarified the prevalence of comorbid mood disorders in substance-dependent individuals, overturning previous assumptions that depression in these patients is simply an artifact of intoxication and/or withdrawal, therefore requiring no treatment. However, our understanding of the bidirectional relationships between mood and substance use disorders in terms of their course(s) of illness and prognoses remains limited. Like-wise, strikingly little treatment research exists to guide clinical decision making in co-occurring mood and substance use disorders, given their high prevalence and public health burden. Here we overview what is known and the salient gaps of knowledge where data might enhance diagnosis and treatment of these complicated patients.
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Affiliation(s)
- Bryan K Tolliver
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Raymond F Anton
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Yen S, Stout R, Hower H, Killam MA, Weinstock LM, Topor DR, Dickstein DP, Hunt JI, Gill MK, Goldstein TR, Goldstein BI, Ryan ND, Strober M, Sala R, Axelson DA, Birmaher B, Keller MB. The influence of comorbid disorders on the episodicity of bipolar disorder in youth. Acta Psychiatr Scand 2016; 133:324-34. [PMID: 26475572 PMCID: PMC4801672 DOI: 10.1111/acps.12514] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Bipolar disorder (BP) frequently co-occurs with other psychiatric disorders. We examine whether course of anxiety disorders (ANX), attention deficit hyperactivity disorder (ADHD), disruptive behavior disorders (DBD), and substance use disorders (SUD) influence likelihood of recovery and recurrence of depression and mania in BP youth. METHOD Weekly ratings of psychiatric disorder intensity were obtained from 413 participants of the Course and Outcome of BP Youth project, followed for an average of 7.75 years. Multiple-event Cox proportional hazards regression analyses examined worsening of comorbid disorders as predictors of mood episode recovery and recurrence. RESULTS Increased severity in ANX and SUD predicted longer time to recovery and less time to next depressive episode, and less time to next manic episode. Multivariate models with ANX and SUD found that significant effects of ANX remained, but SUD only predicted longer time to depression recovery. Increased severity of ADHD and DBD predicted shorter time to recurrence for depressive and manic episodes. CONCLUSION There are significant time-varying relationships between the course of comorbid disorders and episodicity of depression and mania in BP youth. Worsening of comorbid conditions may present as a precursor to mood episode recurrence or warn of mood episode protraction.
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Affiliation(s)
- Shirley Yen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States
,Butler Hospital, Providence, Rhode Island, United States
| | - Robert Stout
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States
,Pacific Institute for Research and Evaluation, Pawtucket, Rhode Island, United States
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Matthew A. Killam
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States
,Butler Hospital, Providence, Rhode Island, United States
| | - David R. Topor
- VA Boston Healthcare System and Harvard Medical School, Cambridge, Massachusetts, United States
| | - Daniel P. Dickstein
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States
,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, United States
| | - Jeffrey I. Hunt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States
,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, United States
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Tina R. Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Benjamin I. Goldstein
- Department of Child Psychiatry, Centre for Youth Bipolar Disorder, University of Toronto Medical Center, Toronto, Ontario, Canada
| | - Neal D. Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, CA, United States
| | - Regina Sala
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College London, England
| | - David A. Axelson
- Department of Psychiatry, Nationwide Children’s Hospital and Ohio State College of Medicine, Columbus, OH, United States
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Kvitland LR, Melle I, Aminoff SR, Lagerberg TV, Andreassen OA, Ringen PA. Cannabis use in first-treatment bipolar I disorder: relations to clinical characteristics. Early Interv Psychiatry 2016; 10:36-44. [PMID: 24739233 DOI: 10.1111/eip.12138] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/28/2014] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to investigate the associations between recent cannabis use, current symptomatology and age at onset of first manic, depressive and psychotic episodes in a large sample with first-treatment bipolar I disorder (BD I). METHODS One hundred one patients with first-treatment Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) bipolar I disorder were included as part of the Thematically Organized Psychosis study. The Structural Clinical Interview for DSM-IV was used for DSM-IV diagnosis and identification of episodes of illness. Earlier suicide attempts were recorded. Manic, depressive and psychotic symptoms were rated using the Young Mania Rating Scale, Inventory of Depressive Symptoms and Positive and Negative Syndrome Scale correspondingly. Cannabis use within the six last months was recorded. RESULTS After controlling for confounders, recent cannabis use was significantly associated with lower age at onset of first manic and psychotic episode, but not with onset of first depressive episode (both P < 0.05). Recent use was also associated with more lifetime suicide attempts (P < 0.01). No group differences were found on symptom levels. CONCLUSIONS The present study confirms earlier findings of an association between cannabis use and a lower age at onset. Recent cannabis use was also associated with more lifetime suicide attempts. The current findings suggest that recent cannabis use is associated with a more severe course of illness in the early phase of BD I.
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Affiliation(s)
- Levi R Kvitland
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo
| | - Sofie R Aminoff
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Trine V Lagerberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo
| | - Petter A Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo
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Secades-Álvarez A, Fernández-Rodríguez C. Review of the efficacy of treatments for bipolar disorder and substance abuse. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 10:113-124. [PMID: 26778814 DOI: 10.1016/j.rpsm.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 11/17/2022]
Abstract
The aim of this study was to provide a descriptive overview of different psychological and pharmacological interventions used in the treatment of patients with bipolar disorder and substance abuse, in order to determine their efficacy. A review of the current literature was performed using the databases Medline and PsycINFO (2005-2015). A total of 30 experimental studies were grouped according to the type of therapeutic modality described (pharmacological 19; psychological 11). Quetiapine and valproate have demonstrated superiority on psychiatric symptoms and a reduction in alcohol consumption, respectively. Group psychological therapies with education, relapse prevention and family inclusion have also been shown to reduce the symptomatology and prevent alcohol consumption and dropouts. Although there seems to be some recommended interventions, the multicomponent base, the lack of information related to participants during treatment, experimental control or the number of dropouts of these studies suggest that it would be irresponsible to assume that there are well established treatments.
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McInnis MG, Greden JF. Longitudinal studies: An essential component for complex psychiatric disorders. Neurosci Res 2016; 102:4-12. [DOI: 10.1016/j.neures.2015.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/17/2015] [Accepted: 05/12/2015] [Indexed: 12/27/2022]
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Carrà G, Bartoli F, Crocamo C, Brady KT, Clerici M. Attempted suicide in people with co-occurring bipolar and substance use disorders: systematic review and meta-analysis. J Affect Disord 2015; 167:125-35. [PMID: 24955564 DOI: 10.1016/j.jad.2014.05.066] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Both individuals with bipolar (BD) and those with alcohol (AUD) and other substance (SUD) use disorders are likely to attempt suicide. Comorbidity of BD and AUD/SUD may increase the likelihood of suicide attempts. We conducted a meta-analysis to estimate the association of comorbid AUD/SUD and suicide attempts in subjects with BD in the literature to date. METHODS Electronic databases through January 2013 were searched. Studies reporting rates of suicide attempts in people with co-occurring BD and AUD/SUD were retrieved. Comorbid AUD and SUD and suicide attempts rates as well as demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors. RESULTS Twenty-nine of 222 studies assessed for eligibility met the inclusion criteria, comprising a total of 31,294 individuals with BD, of whom 6308 (20.1%) had documented suicide attempts. There were consistent findings across the studies included. As compared to controls, subjects with BD and comorbid AUD/SUD were more likely to attempt suicide. The cross-sectional association estimates showed random-effects pooled crude ORs of 1.96 (95% CI=1.56-2.47; p<0.01), 1.72 (95% CI=1.52-1.95; p<0.01), and 1.77 (95% CI=1.49-2.10; p<0.01), for combined AUD/SUD, AUD, and SUD. There was no publication bias and sensitivity analyses based on the highest quality studies confirmed core results. LIMITATIONS The effects of the number and the type of suicide attempts could not be investigated due to insufficient information. CONCLUSIONS Comorbid AUD and SUD in individuals with BD are significantly associated with suicide attempts. Individuals with this comorbidity should be targeted for intensive suicide prevention efforts.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry, University College London, London, UK
| | - Francesco Bartoli
- Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Via Cadore 48, Monza (MB), Italy.
| | - Cristina Crocamo
- Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Via Cadore 48, Monza (MB), Italy
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Charleston, SC, USA
| | - Massimo Clerici
- Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Via Cadore 48, Monza (MB), Italy
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Inder ML, Crowe MT, Luty SE, Carter JD, Moor S, Frampton CM, Joyce PR. Randomized, controlled trial of Interpersonal and Social Rhythm Therapy for young people with bipolar disorder. Bipolar Disord 2015; 17:128-38. [PMID: 25346391 DOI: 10.1111/bdi.12273] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 08/14/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This randomized, controlled clinical trial compared the effect of interpersonal and social rhythm therapy (IPSRT) to that of specialist supportive care (SSC) on depressive outcomes (primary), social functioning, and mania outcomes over 26-78 weeks in young people with bipolar disorder receiving psychopharmacological treatment. METHODS Subjects were aged 15-36 years, recruited from a range of sources, and the patient groups included bipolar I disorder, bipolar II disorder, and bipolar disorder not otherwise specified. Exclusion criteria were minimal. Outcome measures were the Longitudinal Interval Follow-up Evaluation and the Social Adjustment Scale. Paired-sample t-tests were used to determine the significance of change from baseline to outcome period. Analyses of covariance were used to determine the impact of therapy, impact of lifetime and current comorbidity, interaction between comorbidity and therapy, and impact of age at study entry on depression. RESULTS A group of 100 participants were randomized to IPSRT (n = 49) or SSC (n = 51). The majority had bipolar I disorder (78%) and were female (76%), with high levels of comorbidity. After treatment, both groups had improved depressive symptoms, social functioning, and manic symptoms. Contrary to our hypothesis, there was no significant difference between therapies. There was no impact of lifetime or current Axis I comorbidity or age at study entry. There was a relative impact of SSC for patients with current substance use disorder. CONCLUSIONS IPSRT and SSC used as an adjunct to pharmacotherapy appear to be effective in reducing depressive and manic symptoms and improving social functioning in adolescents and young adults with bipolar disorder and high rates of comorbidity. Identifying effective treatments that particularly address depressive symptoms is important in reducing the burden of bipolar disorder.
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Affiliation(s)
- Maree L Inder
- Department of Psychological Medicine, University of Otago, Christchurch
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Kvitland LR, Melle I, Aminoff SR, Demmo C, Lagerberg TV, Andreassen OA, Ringen PA. Continued cannabis use at one year follow up is associated with elevated mood and lower global functioning in bipolar I disorder. BMC Psychiatry 2015; 15:11. [PMID: 25651990 PMCID: PMC4323143 DOI: 10.1186/s12888-015-0389-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/15/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is limited knowledge about how environmental factors affect the course of bipolar disorder (BD). Cannabis has been proposed as a potential risk factor for poorer course of illness, but the role of cannabis use has not been studied in a first treatment BD I sample. METHODS The present study examines the associations between course of illness in first treatment BD I and continued cannabis use, from baseline to one year follow up. Patients (N = 62) with first treatment DSM-IV BD I were included as part of the Thematically Organized Psychosis study (TOP), and completed interviews and self-report questionnaires at both baseline and follow up. Cannabis use within the last six months at baseline and use between baseline and follow up ("continued use") was recorded. RESULTS After controlling for confounders, continued cannabis use was significantly associated with elevated mood (YMRS) and inferior global functioning (GAF-F) at follow up. Elevated mood mediated the effect of cannabis use on global functioning. CONCLUSIONS These results suggest that cannabis use has clinical implications for the early course of BD by increasing mood level. More focus on reducing cannabis use in clinical settings seems to be useful for improving outcome in early phase of the disorder.
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Affiliation(s)
- Levi Roestad Kvitland
- NORMENT, KG Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Building 49, Oslo University Hospital, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424, Oslo, Norway.
| | - Ingrid Melle
- NORMENT, KG Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Building 49, Oslo University Hospital, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424, Oslo, Norway.
| | - Sofie Ragnhild Aminoff
- NORMENT, KG Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Building 49, Oslo University Hospital, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424, Oslo, Norway. .,Division of Mental Health Services, Department of Specialized Inpatient Treatment, Akershus University Hospital, Akershus, Norway.
| | - Christine Demmo
- NORMENT, KG Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Building 49, Oslo University Hospital, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424, Oslo, Norway.
| | - Trine Vik Lagerberg
- NORMENT, KG Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Building 49, Oslo University Hospital, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424, Oslo, Norway.
| | - Ole Andreas Andreassen
- NORMENT, KG Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Building 49, Oslo University Hospital, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424, Oslo, Norway.
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Baek JH, Cha B, Moon E, Ha TH, Chang JS, Kim JH, Choi JE, Kang BJ, Hong KS, Ha K. The effects of ethnic, social and cultural factors on axis I comorbidity of bipolar disorder: results from the clinical setting in Korea. J Affect Disord 2014; 166:264-9. [PMID: 25012440 DOI: 10.1016/j.jad.2014.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Ethnic, social and cultural factors contribute to axis I comorbid conditions in bipolar disorder (BPD). Korea has strict laws against illicit drugs and a relatively permissive prevailing attitude toward alcohol. The present study aimed to explore the lifetime axis I comorbidity rate in patients with BPD in Korea. METHODS Clinically stable patients with bipolar I (n=222) and bipolar II (n=194) disorders were recruited from four tertiary medical centers in Korea. The subjects׳ diagnoses and axis I comorbid conditions were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) and the Korean version of the Diagnostic Interview for Genetic Studies (K-DIGS). The lifetime prevalence of anxiety disorders, substance use disorders and eating disorders was explored. The prevalence of these axis I comorbid conditions was compared with data from prior studies in other countries and to data concerning the general Korean population. RESULTS A total of 45.1% of all subjects had at least one axis I comorbid condition. Anxiety disorders (30.2%) were the most common comorbidity, followed by alcohol use disorders (16.8%). Males with BPD showed a higher rate of alcohol dependence compared to the general male population and females with BPD showed a greater risk of having alcohol use disorder compared to the general female population. The rate of drug use disorder was extremely low (1.7%), and only one subject had an illicit-drug-related problem. LIMITATION Cross-sectional studies. CONCLUSION Comorbid conditions of Korean patients with BPD showed a distinct pattern, which is associated with the ethnic, social and cultural characteristics in Korea.
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Affiliation(s)
- Ji Hyun Baek
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University College of Medicine, Pusan, Republic of Korea
| | - Tae Hyon Ha
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea
| | - Jae Seung Chang
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea
| | - Jeong Hyun Kim
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea
| | - Jung Eun Choi
- Department of Psychiatry, Seoul Municipal Eunpyeong Hospital, San6 Eungam2-Dong, Eunpyeong-Gu, Seoul 122-913, Republic of Korea
| | - Bong Jin Kang
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyooseob Ha
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Kyunggi-Do, Republic of Korea; Seoul National Hospital, Seoul, Republic of Korea.
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Malhi GS, Bargh DM, Coulston CM, Das P, Berk M. Predicting bipolar disorder on the basis of phenomenology: implications for prevention and early intervention. Bipolar Disord 2014; 16:455-70. [PMID: 24636153 DOI: 10.1111/bdi.12133] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 01/02/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Bipolar disorder is a multifaceted illness and there is often a substantial delay between the first onset of symptoms and diagnosis. Early detection has the potential to curtail illness progression and disorder-associated burden but it requires a clear understanding of the initial bipolar prodrome. This article summarizes the phenomenology of bipolar disorder with an emphasis on the initial prodrome, the evolution of the illness, and the implications for prevention and early intervention. METHODS A literature review was undertaken using Medline, Web of Science, and a hand search of relevant literature using keywords (e.g., phenomenology, initial or early symptoms, risk factors, and predictors/prediction). Findings from the literature were reviewed and synthesized and have been put into a clinical context. RESULTS Bipolar disorder is a recurrent, persistent, and disabling illness that typically develops in adolescence or early adulthood. The literature search yielded 28 articles, in which mood lability, nonspecific, non-mood symptoms, and cyclothymic temperament were the most cited prodromal features. CONCLUSIONS A small number of key prospective studies have provided evidence in support of an initial bipolar prodrome; however, methodological differences across studies have prohibited its clear delineation. It is, therefore, not currently possible to anticipate those who will develop bipolar disorder solely on the basis of early phenomenology. Accurate characterization of the bipolar disorder prodrome through high-quality, prospective research studies with adequate control groups will ultimately facilitate prompt and accurate diagnosis.
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Affiliation(s)
- Gin S Malhi
- Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Stephens JR, Heffner JL, Adler CM, Blom TJ, Anthenelli RM, Fleck DE, Welge JA, Strakowski SM, DelBello MP. Risk and protective factors associated with substance use disorders in adolescents with first-episode mania. J Am Acad Child Adolesc Psychiatry 2014; 53:771-9. [PMID: 24954826 PMCID: PMC4288812 DOI: 10.1016/j.jaac.2014.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 03/31/2014] [Accepted: 05/01/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Adolescents with bipolar disorder (BD) are more likely to develop substance use disorders (SUDs) than adolescents without psychiatric disorders; however, to our knowledge, specific risk factors underlying this relationship have not been prospectively examined. The purpose of this study was to identify predictors of developing SUDs after a first manic episode. METHOD Participants aged 12 to 20 years and hospitalized with their first manic episode associated with bipolar I disorder (BP-I) were recruited as part of the University of Cincinnati First-Episode Mania Study and prospectively evaluated for patterns of substance use. Follow-up ranged between 17 and 283 weeks (mean = 113 weeks, SD = 71.9 weeks). Demographic and clinical variables were compared between adolescents with and without SUDs. RESULTS Of the 103 adolescents with BD, 49 (48%) either had a SUD at baseline or developed one during follow-up. Of the 71 participants who did not have a SUD at study entry, 17 (24%) developed one during follow-up (median = 40 weeks). Later onset of BD, manic (versus mixed) mood episode, and comorbid disruptive behavior disorders were associated with an increased risk of developing a SUD in univariate analyses. Adolescents treated with psychostimulant treatment before their first manic episode were significantly less likely to develop a SUD independent of attention-deficit/hyperactivity disorder (ADHD) diagnosis. Comorbid posttraumatic stress disorder (PTSD) and psychotic symptoms were the strongest predictors of SUD development. CONCLUSION Our results confirm high rates of SUD in adolescents with BD. In addition, our findings identify potential risk factors associated with SUDs in adolescents with BD. These data are preliminary in nature and should be explored further in future studies.
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Affiliation(s)
- Jacob R. Stephens
- Research, Observation, Service, Education (ROSE) Program and the Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jaimee L. Heffner
- Fred Hutchinson Cancer Research Center, Seattle, WA, and the Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Caleb M. Adler
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Thomas J. Blom
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Robert M. Anthenelli
- University of California at San Diego, San Diego, CA and the VA San Diego Healthcare System, San Diego, CA
| | - David E. Fleck
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Jeffrey A. Welge
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Stephen M. Strakowski
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
| | - Melissa P. DelBello
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine
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Clinical management and burden of bipolar disorder: results from a multinational longitudinal study (WAVE-bd). Int J Neuropsychopharmacol 2013; 16:1719-32. [PMID: 23663490 DOI: 10.1017/s1461145713000278] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Bipolar disorder is a mood disorder which requires complex treatment. Current treatment guidelines are based on the results of published randomized clinical trials and meta-analyses which may not accurately reflect everyday clinical practice. This multi-national, multi-centre, observational cohort study describes clinical management and clinical outcomes related to bipolar disorder in real-life settings, assesses between-country variability and identifies factors associated with clinical outcomes. Adults from 10 countries in Europe and South America who experienced at least one mood episode in the preceding 12 months were included. Overall, 2896 patients were included in the analyses and followed for at least 9 months across a retrospective and prospective study phase. Main outcome measures were the number and incidence rate of mood episodes (relapses and recurrences) and healthcare resource use including pharmacological treatments. Relapses and recurrences were reported in 18.2 and 40.5% of patients, respectively; however, the reported incidence rate of relapses was higher than that of recurrences [1.562 per person-year (95% CI 1.465-1.664) vs. 0.691 per person-year (95% CI 0.657-0.726)]. Medication use was high during all episode types and euthymia; the percentage of patients receiving no medication ranged from 11.0% in mania to 6.1% in euthymia. Antipsychotics were the most commonly prescribed drug class in all disease phases except for patients with depression, where antidepressants were more frequently prescribed. Visits to the psychiatrist were the most frequently used healthcare resource. These results provide a description of treatment patterns for bipolar disorder across different countries and indicate factors related to relapse and recurrence.
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Kenneson A, Funderburk JS, Maisto SA. Risk factors for secondary substance use disorders in people with childhood and adolescent-onset bipolar disorder: opportunities for prevention. Compr Psychiatry 2013; 54:439-46. [PMID: 23332720 DOI: 10.1016/j.comppsych.2012.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 11/27/2012] [Accepted: 12/06/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Compared to other mental illnesses, bipolar disorder is associated with a disproportionately high rate of substance use disorders (SUDs), and the co-occurrence is associated with significant morbidity and mortality. Early diagnosis of primary bipolar disorder may provide opportunities for SUD prevention, but little is known about the risk factors for secondary SUD among individuals with bipolar disorder. The purposes of this study were to describe the population of people with childhood and adolescent-onset primary bipolar disorder, and to identify risk factors for secondary SUD in this population. METHODS Using data collected from the National Comorbidity Survey Replication study, we identified 158 individuals with childhood-onset (<13 years) or adolescent-onset (13-18 years) primary bipolar disorder (I, II or subthreshold). Survival analysis was used to identify risk factors for SUD. RESULTS Compared to adolescent-onset, people with childhood-onset bipolar disorder had increased likelihoods of attention deficit hyperactivity disorder (ADHD) (adjusted odds ratio=2.81) and suicide attempt (aOR=3.61). Males were more likely than females to develop SUD, and did so at a faster rate. Hazard ratios of risk factors for SUD were: lifetime oppositional defiant disorder (2.048), any lifetime anxiety disorder (3.077), adolescent-onset bipolar disorder (1.653), and suicide attempt (15.424). SUD was not predicted by bipolar disorder type, family history of bipolar disorder, hospitalization for a mood episode, ADHD or conduct disorder. CONCLUSIONS As clinicians struggle to help individuals with bipolar disorder, this study provides information that might be useful in identifying individuals at higher risk for SUD. Future research can examine whether targeting these risk factors may help prevent secondary SUD.
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Affiliation(s)
- Aileen Kenneson
- Center for Integrated Healthcare, Syracuse Veteran's Affairs Medical Center, Syracuse, NY 13210, USA.
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Should an assessment of Axis I comorbidity be included in the initial diagnostic assessment of mood disorders? Role of QIDS-16-SR total score in predicting number of Axis I comorbidity. J Affect Disord 2013; 148:256-64. [PMID: 23273550 DOI: 10.1016/j.jad.2012.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 12/03/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Axis I comorbidity in mood disorders was common in epidemiological studies. This study was designed to investigate the prevalence, pattern, and number of Axis I comorbidities and the role of the Quick Inventory of Depression Symptomatology - 16 items-Self-Report (QIDS-16-SR) in predicting the number of comorbidities in major depressive disorder (MDD) or bipolar disorder (BPD). METHODS Baseline data from the first 300 routine clinical outpatients diagnosed with the Mini International Neuropsychiatric Interview Systematic-Treatment-Enhancement - Program for BPD version 5.0.0 were used. Baseline severity was measured with QIDS-16-SR and Clinical Global Impression-Severity (CGI-S). RESULTS Of 113 patients with MDD and 166 with BPD, the prevalence of any current anxiety disorder (AD), substance use disorder (SUD), and attention deficit hyperactivity disorder (ADHD) was 76% versus 74%, 14% versus 29%, and 8% versus 21%, respectively. The most common patterns of current comorbidity were MDD+AD (58.4%) for MDD, and BPD+AD (39.8%) and BPD+AD+SUD (11.4%) for BPD. More than 80% patients with MDD or BPD had ≥ 1 current comorbid disorder. About 20% patients with BPD and 10% with MDD had ≥ 4 other disorders. The number of comorbidities was positively associated with baseline severity and suicidal ideation in both MDD and BPD. A QIDS-16-SR of 10 had a positive predictive value of ≥ 90% in predicting ≥ 1 comorbidity in MDD and BPD. LIMITATIONS The sample was modest and from a tertiary medical center. CONCLUSION A thorough diagnostic assessment for Axis I comorbidity should be included in all patients with mood disorders, especially when a QIDS-16-SR of ≥ 10 points.
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Rakofsky JJ, Dunlop BW. Do alcohol use disorders destabilize the course of bipolar disorder? J Affect Disord 2013; 145:1-10. [PMID: 22858208 DOI: 10.1016/j.jad.2012.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 06/12/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether long-term data implicate a negative effect of alcohol-use disorders (AUDs) on time to remission, risk of mood episode recurrence, and risk of mood switch/cycling in patients with bipolar disorder (BD). The short-term temporal sequence between alcohol use and onset of mood episodes was also examined. METHODS A MEDLINE literature search was conducted for measurement-based reports of alcohol and course of bipolar disorder. RESULTS Twenty-three original data publications were identified. Three out of 5 studies addressing the impact of AUDs on recovery from a mood episode demonstrated that alcohol did not prolong index mood episodes of any type. Six out of 11 reports evaluating the relationship between alcohol and the long term risk of mood episode recurrences suggested that high levels of alcohol intake increase the risk of a mood recurrence. Five out of 7 studies evaluating the short-term temporal sequence of AUDs and development of mood episodes among BD patients found that increased alcohol use preceded the development of new mood episodes. Four out of 5 studies examining the association between alcohol and rapid cycling indicated that AUDs were associated with higher rates of rapid-cycling. LIMITATIONS We limited our review to studies that were large enough to perform statistical testing, which may have led us to overlook informative smaller studies. CONCLUSIONS Although alcohol does not seem to affect time to mood episode remission, alcohol use destabilizes the course of illness over the long run as evidenced by associations with more rapid cycling and mood episode recurrence.
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Affiliation(s)
- Jeffrey J Rakofsky
- Mood and Anxiety Disorders Program, Emory University, Department of Psychiatry and Behavioral Sciences, 1256 Briarcliff Rd, 3rd Floor North, Atlanta, GA 30306, USA.
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Richardson TH. Substance misuse in depression and bipolar disorder: a review of psychological interventions and considerations for clinical practice. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/17523281.2012.680485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Leelahanaj T, Kongsakon R, Choovanichvong S, Tangwongchai S, Paholpak S, Kongsuk T, Srisurapanont M. Time to relapse and remission of bipolar disorder: findings from a 1-year prospective study in Thailand. Neuropsychiatr Dis Treat 2013; 9:1249-56. [PMID: 24003307 PMCID: PMC3755707 DOI: 10.2147/ndt.s47711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND METHODS This study aimed to determine time to relapse and remission of mood episodes in Thai patients with bipolar disorder (BD). The Thai Bipolar Disorder Registry was a multicenter, prospective, naturalistic, observational study conducted in Thailand. Participants were adult inpatients or outpatients with Diagnostic and Statistical Manual of Mental Disorders bipolar disorder. The diagnosis of bipolar disorder, current psychiatric comorbidity, mood relapse, and mood remission were determined by using the Mini International Neuropsychiatric Interview. Relapse and remission were assessed every 2 months. RESULTS Of 424 BD participants, 404 (95.3%) were BD I, and 258 (60.8%) were female. At entry, 260 (61.3%) had recovered, and 49 (11.6%) were recovering. During 1-year follow-up (381.7 person-years), 92 participants (21.7%) had 119 relapses or 0.31 (95% confidence interval 0.25-0.35) episodes per person-year. Among 119 relapses, 58 (48.7%), 39 (32.7%), and 21 (17.6%) of them were depressive, hypomanic, and manic episodes, respectively. Using the Kaplan-Meier method, we found that 25% of the participants relapsed in 361 days. Of the 400 participants who reached remission, 113 (28.2%) had mood relapses. Of 173 mood events accountable for remission analysis, the median time to remission was 67.5 days (72.5 days for depressive episodes versus 58.0 days for manic episodes, log rank P = 0.014). CONCLUSIONS The 1-year relapse rate in Thai patients with BD was 21.7% or 0.31 episodes per person-year. About one-fifth of recovered patients had mood relapses within 371 days. On average, a mood episode would remit in 67.5 days.
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