Specificity of Bipolar Spectrum Conditions in the Comorbidity of Mood and Substance Use Disorders

Section on Developmental Genetic Epidemiology, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, 1A201 35 Convent Dr, MSC 3720, Bethesda, MD 20892-2670, USA.
Archives of general psychiatry (Impact Factor: 14.48). 02/2008; 65(1):47-52. DOI: 10.1001/archgenpsychiatry.2007.18
Source: PubMed


Although an association between mood disorders and substance use disorders has been well established, there is a lack of long-term prospective data on the order of onset and subtypes of mood disorders associated with specific substances and their progression.
To estimate the respective risks posed by subtypes of mood disorders or bipolar spectrum conditions for the subsequent development of substance use disorders.
Six waves of direct diagnostic interviews were administered to a sample of young adults during a 20-year period. Mood disorders and syndromes assessed at each interview were used to predict the cumulative incidences of substance use disorders at subsequent interview waves.
We followed up 591 individuals (292 men and 299 women) who were selected at study enrollment from a representative sample of young adults in Zurich, Switzerland.
Structured Diagnostic Interview for Psychopathologic and Somatic Syndromes, a semistructured clinical interview that collected data on the spectrum of expression of mood disorders and substance use and disorders for DSM-III-R and DSM-IV criteria.
Individuals having manic symptoms were at significantly greater risk for the later onset of alcohol abuse/dependence, cannabis use and abuse/dependence, and benzodiazepine use and abuse/dependence. Bipolar II disorder predicted both alcohol abuse/dependence and benzodiazepine use and abuse/dependence. In contrast, major depression was predictive only of later benzodiazepine abuse/dependence.
In comparison with major depression, bipolar II disorder was associated with the development of alcohol and benzodiazepine use and disorders. There was less specificity of manic symptoms that tended to predict all levels of the substances investigated herein. The different patterns of association between mood disorders and substance use trajectories have important implications for prevention and provide lacking information about underlying mechanisms.

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    • "It is well known that mental disorders are accompanied by multiple comorbidities, but substance misuse is particularly common [1]. Many clinicians feel that substance misuse may be explained in some cases as a form of self-medication to improve psychopathology (depression, anhedonia, and negative symptoms) or to ameliorate the side effects of psychopharmacological treatment. "
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    ABSTRACT: Objective: Comorbidities between psychiatric diseases and consumption of traditional substances of abuse (alcohol, cannabis, opioids, and cocaine) are common. Nevertheless, there is no data regarding the use of novel psychoactive substances (NPS) in the psychiatric population. The purpose of this multicentre survey is to investigate the consumption of a wide variety of psychoactive substances in a young psychiatric sample and in a paired sample of healthy subjects. Methods: A questionnaire has been administered, in different Italian cities, to 206 psychiatric patients aged 18 to 26 years and to a sample of 2615 healthy subjects matched for sex, gender, and living status. Results: Alcohol consumption was more frequent in the healthy young population compared to age-matched subjects suffering from mental illness (79.5% versus 70.7%; P < 0.003). Conversely, cocaine and NPS use was significantly more common in the psychiatric population (cocaine 8.7% versus 4.6%; P = 0.002) (NPS 9.8% versus 3%; P < 0.001). Conclusions: The use of novel psychoactive substances in a young psychiatric population appears to be a frequent phenomenon, probably still underestimated. Therefore, careful and constant monitoring and accurate evaluations of possible clinical effects related to their use are necessary.
    BioMed Research International 07/2014; 2014. DOI:10.1155/2014/815424 · 2.71 Impact Factor
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    • "Similar to Costello et al. (2007) and Farmer et al. (1999), our results demonstrate that bipolar disorder was far more likely to be treated among older than younger adolescents, likely because of greater comorbidity and severity. This finding is of particular importance for prevention in that early recognition and intervention for manic episodes may lead to the prevention of secondary disorders like substance use (Merikangas et al. 2008). Examining the relationship between age and patterns of treatment seeking and response in epidemiological samples is particularly crucial given recent evidence from nationally representative samples of potentially differentiable developmental trajectories of bipolar disorder (Cicero et al. 2009). "
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    ABSTRACT: Despite growing evidence that bipolar disorder often emerges in adolescence, there are limited data regarding treatment patterns of youth with bipolar disorder in community samples. Our objective was to present the prevalence and clinical correlates of treatment utilization for a nationally representative sample of US adolescents with bipolar disorder. Analyses are based on data from the National Comorbidity Survey-Adolescent Supplement, a face-to-face survey of 10,123 adolescents (ages 13-18) identified in household and school settings. We found that of adolescents meeting DSM-IV criteria for bipolar I or II disorder (N = 250), 49 % were treated for depression or mania, 13 % were treated for conditions other than depression or mania, and 38 % did not report receiving treatment. Treatment for depression or mania was associated with increased rates of suicide attempts, as well as greater role disability and more comorbid alcohol use relative to those who had not received treatment. Treated adolescents had triple the rate of ADHD and double the rates of behavior disorders than those without treatment. Our findings demonstrate that a substantial proportion of youth with bipolar disorder do not receive treatment, and of those who do, many receive treatment for comorbid conditions rather than for their mood-related symptoms. Treatment was more common among youth with severe manifestations and consequences of bipolar disorder and those with behavior problems. These trends highlight the need to identify barriers to treatment for adolescents with bipolar disorder and demonstrate that those in treatment are not representative of youth with bipolar disorder in the general population.
    Journal of Abnormal Child Psychology 06/2014; 43(2). DOI:10.1007/s10802-014-9885-6 · 3.09 Impact Factor
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    • "Alcohol and substance related problems in the hypomania spectrum and MDD groups were low both in adolescence and adulthood, despite the co-occurrence of mood and substance use disorders in previous community samples [63-65]. The surprisingly low rate of substance use disorders could be the result of a low response-rate among individuals with these disorders or of low rates of substance use in Sweden in general [66]. "
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    ABSTRACT: We investigated whether adolescents with hypomania spectrum episodes have an excess risk of mental and physical morbidity in adulthood, as compared with adolescents exclusively reporting major depressive disorder (MDD) and controls without a history of adolescent mood disorders. A community sample of adolescents (N = 2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes (40 full-syndromal, 18 with brief episode, and 32 subsyndromal), while another 197 fulfilled the criteria for MDD without a history of a hypomania spectrum episode. A follow up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. The participation rate at the follow-up interview was 71 % (64/90) for the hypomania spectrum group, and 65.9 % (130/197) for the MDD group. Multiple imputation was used to handle missing data. The outcomes of the hypomania spectrum group and the MDD group were similar regarding subsequent non-mood Axis I disorders in adulthood (present in 53 vs. 57 %). A personality disorder was reported by 29 % of the hypomania spectrum group and by 20 % of the MDD group, but a statistically significant difference was reached only for obsessive-compulsive personality disorder (24 vs. 14 %). In both groups, the risk of Axis I disorders and personality disorders in adulthood correlated with continuation of mood disorder. Prescription drugs and health service use in adulthood was similar in the two groups. Compared with adolescents without mood disorders, both groups had a higher subsequent risk of psychiatric morbidity, used more mental health care, and received more psychotropic drugs. Although adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes, both groups are at increased risk for subsequent mental health problems. Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course.
    BMC Psychiatry 01/2014; 14(1):9. DOI:10.1186/1471-244X-14-9 · 2.21 Impact Factor
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