Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: a controlled study.

Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA.
Drug and Alcohol Dependence (Impact Factor: 3.42). 06/2008; 95(3):188-98. DOI: 10.1016/j.drugalcdep.2007.12.016
Source: PubMed


Although previous work suggests that juvenile onset bipolar disorder increases risk for substance use disorders and cigarette smoking, the literature on the subject is limited. We evaluated the association of risk for substance use disorders and cigarette smoking with bipolar disorder in adolescents in a case-control study of adolescents with bipolar disorder (n=105, age 13.6+/-2.5 years [mean]; 70% male) and without bipolar disorder ("controls"; n=98, age 13.7+/-2.1 years; 60% male). Rates of substance use and other disorders were assessed with structured interviews (KSADS-E for subjects younger than 18, SCID for 18-year-old subjects). Bipolar disorder was associated with a significant age-adjusted risk for any substance use disorder (hazard ratio[95% confidence interval]=8.68[3.02 25.0], chi(2)=16.06, p<0.001, df=1), alcohol abuse (7.66 [2.20 26.7], chi(2)=10.2, p=0.001, df=1), drug abuse (18.5 [2.46 139.10], chi(2)=8.03, p=0.005, df=1) and dependence (12.1 [1.54 95.50], chi(2)=5.61, p=0.02, df=1), and cigarette smoking (12.3 [2.83 53.69], chi(2)=11.2, p<0.001, df=1), independently of attention deficit/hyperactivity disorder, multiple anxiety, and conduct disorder (CD). The primary predictor of substance use disorders in bipolar youth was older age (BPD-SUD versus BPD+SUD, logistic regression: chi(2)=89.37, p<0.001). Adolescent bipolar disorder is a significant risk factor for substance use disorders and cigarette smoking, independent of psychiatric comorbidity. Clinicians should carefully screen adolescents with bipolar disorder for substance and cigarette use.

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    • "Along with severity of depression and having made a prior suicide attempt, smoking was a robust predictor of suicidal behavior following a major depressive episode in bipolar disorder, even after controlling for other factors [8] and regardless of gender [9]. Additionally, a study of adolescents with bipolar disorder found that cigarette smoking was independently associated with suicide attempts and substance use disorders [10,11]. "
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    ABSTRACT: Cigarette smoking is the single largest preventable cause of death and disability in the industrialized world and it causes at least 85% of lung cancers, chronic bronchitis and emphysema. In addition smokers are at a higher risk from psychiatric co-morbid illness such as depression and completed suicide. We conducted a cross-sectional survey in which we targeted all patients with serious mental illness (SMI) who were admitted in Razi mental health Hospital in Tehran, Iran. We recruited 984 participants, who were receiving services from Razi mental health Hospital and hospitalized for at least two days between 21 July to 21 September, 2010. Nine hundred and fifty patients out of this figure were able to participate in our study. The final study sample (n = 950) consisted of 73.2% males and 26.8% females. The mean age was 45.31 (SD=13.7). A majority of participants (70%) was smoker. A history of never smoking was present for 25.2% of the study sample; while 4.8% qualified as former smokers and 70.0% as occasional or current smokers. Two hundred and nineteen participants had attempted suicide amongst them 102 (46.6%) once, 37 (16.9%) twice, and 80 (36.5%) attempted more than two times in their life time. In regression model, gender, age, and cigarette consumption were associated with previous suicide attempts and entered the model in this order as significant predictors. There is an association of cigarette smoking and suicide attempt in psychiatric inpatients. Current smoking, a simple clinical assessment, should trigger greater attention by clinicians to potential suicidality and become part of a comprehensive assessment of suicide risk.
    Tobacco Induced Diseases 02/2013; 11(1):5. DOI:10.1186/1617-9625-11-5 · 1.50 Impact Factor
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    • "Prospective data suggest that bipolar disorder during adolescence is a risk factor for the subsequent development of a substance use disorder (Geller, Tillman, Bolofner & Zimerman, 2008; Goldstein & Bukstein, 2010; Wilens et al., 2008 see Jerrell, McIntyre & Tripathi, 2010 see also Jerrell, McIntyre & Tripathi, 2010) and that adolescents with comorbid bipolar and substance use disorders have significant functional impairment and high suicide risk (Goldstein & Bukstein, 2010). Additionally, these adolescents use more outpatient and acute medical and psychiatric services (Jerrell et al., 2010). "
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    ABSTRACT: OBJECTIVE: The aim of this report was to examine the accuracy of diagnosing substance use disorders in manic adolescents with bipolar disorder. METHODS: The substance use disorder modules of the KSADS-PL were administered to a sample of 80 manic adolescents (12-21 years old) with co-occurring bipolar and substance use disorders. Initial substance use disorder diagnoses obtained from the KSADS-PL were then compared to a best-estimate diagnosis derived from all available information, including a second diagnostic interview, the Child Semi-Structured Assessment for the Genetics of Alcoholism, Adolescent version (C-SSAGA-A). RESULTS: Relatively low diagnostic agreement was achieved across the initial and the best estimate diagnoses for both alcohol and cannabis use disorders. Age, race, and sex did not predict diagnostic agreement between the two evaluations. CONCLUSIONS: Results of this study call for more research on diagnosing substance use disorders and suggest that a single interview alone may not be accurate for diagnosing substance use disorders in manic adolescents with bipolar disorder.
    Journal of Dual Diagnosis 10/2012; 8(1):13-18. DOI:10.1080/15504263.2012.647349 · 0.80 Impact Factor
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    • "BP-I subjects (Wozniak et al., 2005; Wilens et al., 2008) met criteria for DSM-IV BP-I disorder and Controls (Wilens et al., 2008) were non-mood disordered. Psychiatric assessments relied on the Kiddie Schedule for Affective Disorders and Schizophrenia Epidemiologic Version (K-SADS-E) for DSM-IV (Orvaschel, 1994) for subjects younger than 18 years of age and the Structured Clinical Interview for DSM-IV (SCID) (First et al., 1997) (supplemented with modules from the K-SADS-E to assess childhood diagnoses) for subjects 18 years of age. "
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    Psychiatry Research 03/2011; 186(1):58-64. DOI:10.1016/j.psychres.2010.08.029 · 2.47 Impact Factor
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