Different profile of substance abuse in relation to predominant polarity in bipolar disorder: The Vitoria long-term follow-up study
ABSTRACT There is a need for comparisons of long-term outcomes in bipolar disorder patients with predominantly manic symptoms vs. predominantly depressive symptoms, especially the course of comorbid alcohol/substance abuse.
A naturalistic sample of bipolar I patients (n=120) was followed prospectively for up to 10years. At baseline, number and polarity of past episodes were used to classify patients as predominantly manic or predominantly depressive if there were more manic or more depressive episodes, respectively. 25 patients were excluded from the analyses. Outcomes including episodes, hospitalisations and suicide attempts were recorded at bimonthly visits. Mixed effects models compared the course of alcohol and other substance abuse in predominantly manic vs. depressive patients.
Of the 95 patients analyzed, 44 (46.3%) had predominantly manic episodes and 51 (53.7%) had predominantly depressive episodes. At baseline, the predominantly depressive group had more history of suicide attempts (45.1% vs. 20.5%; p=0.021) and more family history of affective disorders (64.7% vs. 38.6%; p=0.020), but they had fewer previous hospitalisations than the manic group (mean 0.38 vs. 0.50; p=0.025). During the 10-year follow-up, the predominantly depressive group was associated with more episodes (p=0.001), more hospitalisations (p=0.004) and more suicide attempts (p=0.002). At baseline, there were no differences between the manic and depressive groups in the frequency of alcohol abuse (43.2% and 35.3%, p=0.565) or other substance abuse (13.6% and 9.8%, p=0.794). During the 10-year follow-up, the frequency of alcohol and other substance abuse decreased significantly in the manic group only, after controlling by age at onset and civil (marital) status.
Long-term clinical outcomes differ between predominantly manic vs. depressive bipolar patients, with the predominantly depressive group having a worse prognosis and maintained alcohol and other substance abuse. These differences should be considered when designing treatment approaches for bipolar patients with comorbid alcohol/substance abuse.
- SourceAvailable from: Susana Al-Halabí
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- "For a comprehensive review, see Sanchez- Moreno et al. (2009). Among all the studied variables, the presence of depressive symptoms has been reported as the strongest predictor of poor outcome (Judd et al., 2005; Gitlin et al., 2011; Bonnin et al., 2010; Martino et al., 2009; Strejilevich et al., 2013; Gonzalez-Pinto et al., 2010). This symptomatology also affects neurocognitive performance, even at low levels of depressive symptoms (Bonnin et al., 2012; Torrent et al., 2012). "
ABSTRACT: Background Most studies on the factors involved in the functional outcome of patients with bipolar disorder have identified subsyndromal depressive symptoms and cognitive impairment as key players. However, most studies are cross-sectional and very few have analyzed the interaction between cognition and subclinical depression. The present study aimed to identify the role of cognition, and particularly verbal memory, and subthreshold depressive symptoms in the functional outcome of patients with bipolar I and II disorder at one year follow-up. Method A confirmatory analysis was performed using the path analysis. A total of 111 euthymic patients were included to test the role of verbal memory as a mediator in the relationship of subthreshold depressive symptoms and functional outcome at one year follow-up. Measures of verbal memory, subthreshold depressive symptoms and functioning (at baseline, at 6 months and at one year follow-up) were gathered through the use of a neuropsychological assessment and validated clinical scales. Results The hypothesized mediation model displayed a good fit to data (Chi=0.393, df=2, p=0.625; RMSEA<0.001 with CI: 0.001–0.125 and CFI=1.00). Functional outcome at one year follow-up was predicted by the functional outcome at baseline, which in turn, was related to subthreshold depressive symptoms at baseline and to the verbal composite memory scores as a mediator variable. Conclusion The results of this study prospectively confirm previous findings on the disabling role of subthreshold depressive symptoms and verbal memory impairment on psychosocial functioning. However, these results come from a sample with moderate to severe functional impairment; hence, as a limitation, this may hinder the generalization of these results.Journal of Affective Disorders 05/2014; 160:50–54. DOI:10.1016/j.jad.2014.02.034 · 3.71 Impact Factor
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- "There is significant overlapping between behaviours in some types of psychiatric disorders and drug-related behaviours: maladaptive behaviours, such as those commonly displayed by drug-addicts, may sometimes be due to, or accentuated by, concurrent psychiatric disorders. Thus, a low degree of compliance with therapies is a common symptom of drug addiction and of several forms of psychiatric disorders; this may be devastating in bipolar 1 diagnosis heroin addicts, whose history often includes an earlier onset of drug abuse, a worse course of illness, and a frequent need for hospitalization (Baigent, 2012; Brady and Sonne, 1995; Gonzalez-Pinto et al., 2010; Sajatovic et al., 2009). However, patients were followed up for 3 years on average, and diagnoses were subject to revision whenever further clinical evidence or retrospective information was gathered – a factor that reduces the likelihood of false NDDs. "
ABSTRACT: The aim of this study was to compare the long-term outcomes of treatment-resistant bipolar 1 heroin addicts with peers who were without DSM-IV axis I psychiatric comorbidity (dual diagnosis). 104 Heroin-dependent patients (TRHD), who also met criteria for treatment resistance - 41 of them with DSM-IV-R criteria for Bipolar 1 Disorder (BIP1-TRHD) and 63 without DSM-IV-R axis I psychiatric comorbidity (NDD-TRHD) - were monitored prospectively (3 years on average, min. 0.5, max. 8) along a Methadone Maintenance Treatment Programme (MMTP). The rates for survival-in-treatment were 44% for NDD-TRHD patients and 58% for BIP1-TRHD patients (p=0.062). After 3 years of treatment such rates tended to become progressively more stable. BIP1-TRHD patients showed better outcome results than NDD-TRHD patients regarding CGI severity (p<0.001) and DSM-IV GAF (p<0.001). No differences were found regarding urinalyses for morphine between groups during the observational period. Bipolar 1 patients needed a higher methadone dosage in the stabilization phase, but this difference was not statistically significant. The observational nature of the protocol, the impossibility of evaluating a follow-up in the case of the patients who dropped out, and the multiple interference caused by interindividual variability, the clinical setting and the temporary use of adjunctive medications. Contrary to expectations, treatment-resistant patients with bipolar 1 disorder psychiatric comorbidity showed a better long-term outcome than treatment-resistant patients without psychiatric comorbidity.Journal of Affective Disorders 08/2013; DOI:10.1016/j.jad.2013.06.054 · 3.71 Impact Factor
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- "Compared to pure manic episodes, the clinical picture of mixed mania shows that patients tend to experience more episodes of illness, with episodes of longer duration (Martin- Carrasco et al., 2012) and more functional impairment (Rosa et al., 2009). In addition, they are more likely to have experienced previous mixed episodes, to relapse, to have lower interepisode intervals with a higher risk of a future mixed episode, and to have higher rates of suicide and comorbid conditions such as substance abuse (Azorin et al., 2009; Baldessarini et al., 2010; Cassidy et al., 2008; Gonzalez-Pinto et al., 2010; Kessing, 2008; Valenti et al., 2011). Similar to mixed mania, mixed depressive patients differ from pure bipolar depressives in that they are more likely to show a mixed state at the first episode; have more severe episodes of longer duration; have less interepisodic remission; have higher recurrence rates of depressive or hypomanic episodes; have more rapid cycling; have more previous mixed episodes; and have more incongruent psychotic features, suicide attempts, and alcohol abuse (Akiskal et al., 2005; Azorin et al., 2012; Goldberg et al., 2009; Perugi et al., 2001). "
ABSTRACT: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) nomenclature for the co-occurrence of manic and depressive symptoms (mixed states) has been revised in the new DSM-5 version to accommodate a mixed categorical-dimensional concept. The new classification will capture subthreshold non-overlapping symptoms of the opposite pole using a "with mixed features" specifier to be applied to manic episodes in bipolar disorder I (BD I), hypomanic, and major depressive episodes experienced in BD I, BD II, bipolar disorder not otherwise specified, and major depressive disorder. The revision will have a substantial impact in several fields: epidemiology, diagnosis, treatment, research, education, and regulations. The new concept is data-driven and overcomes the problems derived from the extremely narrow definition in the DSM-IV-TR. However, it is unclear how clinicians will deal with the possibility of diagnosing major depression with mixed features and how this may impact the bipolar-unipolar dichotomy and diagnostic reliability. Clinical trials may also need to address treatment effects according to the presence or absence of mixed features. The medications that are effective in treating mixed episodes per the DSM-IV-TR definition may also be effective in treating mixed features per the DSM-5, but new studies are needed to demonstrate it.Journal of Affective Disorders 04/2013; 148(1). DOI:10.1016/j.jad.2013.03.007 · 3.71 Impact Factor