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: 3.28). 06/2008; 95(3):188-98. DOI: 10.1016/j.drugalcdep.2007.12.016
Source: PubMed

ABSTRACT 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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Available from: Aude Henin, Jul 28, 2015
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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 01/2012; 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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    ABSTRACT: Although psychometrically-defined executive function deficits (EFDs) and ecologically valid functional outcomes have been documented among youth with bipolar I (BP-I) disorder, little is known about their association. We hypothesized that EFDs would be associated with significant ecologically valid impairments beyond those predicted by having BP-I disorder. Youth with BP-I disorder were ascertained from psychiatric clinics and community sources. We defined EFDs as having at least two out of eight EF measures impaired from a battery of six tests. Significantly more youth with BP-I disorder had EFDs than controls (45% versus 17%). Comparisons were made between controls without EFDs (N=81), controls with EFDs (N=17), BP-I youth without EFDs (N=76), and BP-I youth with EFDs (N=62). EFDs were associated with an increased risk for placement in a special class and a decrease in academic achievement (WRAT-3 reading and arithmetic). EFDs in BP-I subjects were associated with an increased risk for speech/language disorder (as assessed in the K-SADS-E) relative to BP-I subjects without EFDs. Youth with BP-I disorder and EFDs are at high risk for significant impairments in academic functioning.
    Psychiatry Research 03/2011; 186(1):58-64. DOI:10.1016/j.psychres.2010.08.029 · 2.68 Impact Factor
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    • "Considerations for classification—Given that substance dependence has been associated with both bipolar I and II (Compton et al., 2007; Grant et al., 2004; Hasin et al., 2007; Merikangas et al., 2007), both variants were combined into a general BPD category as in previous research (Wilens et al., 2008). In concordance with extant reports (Compton et al., 2007; Grant et al., 2004; Hasin et al., 2007; Merikangas et al., 2007), all illicit and prescription drug dependences were analyzed as a combined drug dependence category to increase prevalence and reduce the number of comparisons. "
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    ABSTRACT: Previous studies have shown that both bipolar disorder (BPD) and psychomotor agitation (PMA) are associated with substance dependence. These two findings have yet to be integrated, despite evidence that PMA is closely linked with the bipolar spectrum. Accordingly, the current study examined whether BPD and PMA had unique or overlapping associations with substance dependence disorders. Participants were 2,300 individuals seeking outpatient psychiatric treatment. Before treatment, participants were assessed using structured clinical interviews, which yielded DSM-IV psychiatric diagnoses and clinical ratings of mood symptoms. Current PMA and lifetime BPD were present in 483 and 172 (bipolar I, n = 71; bipolar II, n = 101) participants, respectively. Current PMA and lifetime BPD each were associated with increased prevalence of lifetime nicotine, alcohol, and drug dependence (ORs >or= 1.52, ps <or= .0004). These associations remained significant when controlling for demographic characteristics and comorbid psychiatric disorders, except the link between agitation and alcohol dependence, which was reduced to a trend (p = .058). Although BPD and PMA were associated with each other, these two factors demonstrated unique, nonoverlapping relationships to nicotine, alcohol, and drug dependence. Individuals with both PMA and BPD exhibited especially high rates of comorbid substance dependence. The present results replicate and extend previous findings documenting the relations of BPD and PMA to substance dependence. BPD and PMA may represent independent psychopathological correlates of substance dependence. Future research should explore the theoretical and clinical significance of these potentially distinct relations to substance dependence.
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