Independent Predictors for Lifetime and Recent Substance Use Disorders in Patients with Rapid-Cycling Bipolar Disorder: Focus on Anxiety Disorders

Department of Psychiatry, Bipolar Disorder Research Center at Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
American Journal on Addictions (Impact Factor: 1.74). 08/2010; 19(5):440-9. DOI: 10.1111/j.1521-0391.2010.00060.x
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We set out to study independent predictor(s) for lifetime and recent substance use disorders (SUDs) in patients with rapid-cycling bipolar disorder (RCBD). Extensive Clinical Interview and Mini-International Neuropsychiatric Interview were used to ascertain DSM-IV Axis I diagnoses of RCBD, anxiety disorders, and SUDs. Data from patients enrolling into four similar clinical trials were used. Where appropriate, univariate analyses with t-test or chi-square were applied. Stepwise logistic regression was used to examine the relationship among predictor variables and lifetime and recent SUDs. Univariate analysis showed that patients with co-occurring anxiety disorders (n = 261) had significantly increased rates of lifetime (odds ratio [OR]= 2.1) and recent (OR = 1.9) alcohol dependence as well as lifetime (OR = 3.4) and recent (OR = 2.5) marijuana dependence compared to those without co-occurring anxiety disorder (n = 303). In logistic regression analyses, generalized anxiety disorder (GAD) was associated with increased risk for lifetime SUDs (OR = 2.34), alcohol dependence (OR = 1.73), and marijuana dependence (OR = 3.36) and recent marijuana dependence (OR = 3.28). A history of physical abuse was associated with increased risk for lifetime SUDs (OR = 1.71) and recent marijuana dependence (OR = 3.47). Earlier onset of first mania/hypomania was associated with increased risk for lifetime SUDs (5% per year), and recent marijuana dependence (12% per year) and later treatment with a mood stabilizer were also associated with increased risk for recent SUDs (8% per year). Positive associations between GAD, later treatment with a mood stabilizer, and early childhood trauma and history of SUDs suggest that adequate treatment of comorbid anxiety, early treatment with a mood stabilizer, and prevention of childhood trauma may reduce the risk for the development of SUDs in patients with bipolar disorder.

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    • "Although obesity and impulsivity are common and shared features of RC-BD, their relationship in RC-BD remains to be established (Gao et al., 2008; Kemp et al., 2010; McElroy et al., 2011). "
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    ABSTRACT: Background Obesity seems to show a two-way relationship with bipolar disorder (BD), representing not only a possible vulnerability factor but also a consequence of chronic mood dysregulation associated with an overall poor prognosis. Increased impulsivity has been described across all stages and phases of BD as being also associated with a worse prognosis. Although obesity and impulsivity are common features among rapid cycling bipolar disorder (RC-BD) patients, there is a lack of understanding about the clinical implications of these conditions combined in BD. Methods To explore and integrate available evidence on shared clinical associations between obesity and impulsivity in RC-BD a systematic search of the literature in the electronic database of the National Library of Medicine (PubMed) has been conducted. Results One hundred and fourteen articles were included in our systematic review. Among RC-BD patients, substance abuse disorders (SUDs), anxiety disorders (ADs), predominantly depressive polarity, chronic exposure to antidepressants, psychotic symptoms, suicidality, and comorbid medical conditions are strongly associated with both obesity and impulsivity. Limitations Heterogeneity of published data, inconsistent measurements of both obesity and impulsivity in RC-BD and an absence of control for RC-BD in epidemiological surveys. Consequently, their combined impact on the severity of RC-BD is yet to be recognized and remains to be poorly understood. Conclusion In RC-BD patients the co-occurrence of obesity and impulsivity is associated with an unfavorable course of illness, specific shared clinical correlates, negative psychosocial impact, and overall worse prognosis. There is a need to examine obesity and impulsivity as modulating factors and markers of severity in RC-BD.
    Journal of Affective Disorders 06/2014; 168. DOI:10.1016/j.jad.2014.05.054 · 3.38 Impact Factor
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    • "Bipolar patients with high anxiety rates have longer, more frequent and more difficult to treat mood episodes; they also show greater functional impairment, greater substance abuse, and earlier onset of mood illness (Feske et al., 2000; Frank et al., 2002; Otto et al., 2006). Additionally, adequate treatment of comorbid anxiety has been suggested to reduce the risk for the development of substance use disorder in patients with BP (Gao et al., 2010). Milder anxiety phenotypes such as anxious temperament (increased behavioral and physiological reactivity to mildly threatening stimuli) have also been documented not only in humans but also in primates (Fox et al., 2008). "
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    ABSTRACT: High comorbidity rates for anxiety have been documented in subjects with history of mania or hypomania. We explored the presence of latent constructs of quantitative anxiety in subjects who have a history of mania or hypomania. We conducted an exploratory factor analysis of anxiety trait in 212 subjects who have a lifetime history of at least one manic/hypomanic syndrome. Participants were originally recruited for a Costa Rican sibling pair genetic study of Bipolar Disorder. We used principal factors extraction method with squared multiple correlations (SAS/SAT Professional software) of the STAI (trait subscale). A three-factor solution with a good simple structure and statistical adequacy was obtained with a KMO of 0.84 (>0.6) and Bartlett's Test of Sphericity of 2.4668E-162 (p<0.05). Items were grouped into anxiety-absent factor and the anxiety-present symptoms in two additional factors based on the nature of the symptoms, worry and rumination. Comorbid disorders could affect the interaction of anxiety score with manic/hypomanic symptoms. Some statistical parameters (mood status independence, score distribution and correlation between trait score and quantitative mania/hypomania) were not taken into consideration to extract the factors. Because anxiety dimensions were explored on individuals with history of mania or hypomania and not in healthy subjects, comparison of our results with other studies can draw confusing conclusions. Two underlying constructs, worry and rumination may explain anxiety sub-syndromic symptoms in Costa Rican patients with history of mania or hypomania.
    Journal of Affective Disorders 07/2011; 136(1-2):e69-75. DOI:10.1016/j.jad.2011.06.036 · 3.38 Impact Factor
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    • "It is not surprising, then, that bipolar patients, with or without cooccurring alcohol use disorders, have very high rates of additional psychiatric problems (McElroy et al., 2001). Work on this topic has increasingly focused on the particular combination of bipolar, substance use, and anxiety disorders (Simon et al., 2004a; Kolodziej et al., 2005; Levander et al., 2007; Goldstein and Levitt, 2008; Gao et al., 2010). Simon et al. (2004a, 2004b) demonstrated that 40% of bipolar patients with alcohol dependence from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were diagnosed with at least one current anxiety disorder. "
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    ABSTRACT: Despite the high prevalence and detrimental impact of alcoholism on bipolar patients, the diagnostic and treatment factors associated with better or worse clinical outcomes in alcohol-dependent patients with bipolar disorder are not well understood. The present study investigated the prospective impact of baseline psychiatric comorbidities and treatment regimens on clinical outcomes in bipolar alcoholics. Data were drawn from an 8-week randomized controlled clinical trial of acamprosate for individuals (n=30) with co-occurring bipolar disorder and alcohol dependence. Depressive and manic symptoms, and alcohol craving and consumption were monitored longitudinally using standardized instruments. Path analysis was used to estimate the prospective associations between patient characteristics and outcomes. More than 50% of patients were diagnosed with at least one anxiety (76.7%) or drug dependence disorder (60.0%). Comorbid anxiety disorders were prospectively associated with increased depressive symptoms and alcohol use. Participants were prescribed an average of 2.6 psychotropic medications at baseline. Antipsychotics and anticonvulsants were prospectively associated with increased alcohol use; anticonvulsants and benzodiazepines were associated with increased alcohol craving. Antidepressants were associated with increased depressive symptoms. Conversely, lithium was associated with decreased alcohol craving and depressive symptoms. The findings from the present study suggest areas for future research in this population.
    Psychiatry Research 06/2011; 188(3):361-5. DOI:10.1016/j.psychres.2011.04.030 · 2.47 Impact Factor
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