Despite a high prevalence rate, patients with bipolar disorder and active alcohol use are routinely excluded from controlled clinical trials leaving clinicians with little evidence-based medicine to guide treatment. This report evaluates preliminary data of alcohol consumption patterns utilizing the Alcohol Timeline Followback (TLFB) method in actively drinking patients with bipolar disorder.
A sample of 30 patients underwent a Structured Diagnostic Interview for DSM-IV (SCID-IV) as well as completing various measures of alcohol use and associated morbidity.
In the month prior to study entry, the TLFB reported 18.4/30+/-9.12 drinking days, 9.9+/-4.73 drinks per drinking day and 169.4+/-101.71 total standard drinks for this study group. There was a significant difference in the number of drinks per drinking day between those diagnosed with rapid cycling than non-rapid cycling bipolar disorder and those with a new diagnosis versus established diagnosis of bipolar disorder.
This study highlights heavy alcohol use in patients with bipolar disorder and alcohol comorbidity. The TLFB method provides 'real world' quantification of use. Further studies are encouraged to elucidate implications of heavy drinking patterns as found in our rapid cycling and newly diagnosed cohorts.
"First, many studies have evaluated associations between retrospective self-reported lifetime diagnosis and illness course variables for bipolar disorder, AUD, or both (Fossey et al., 2006; Weiss et al., 2005; Reich et al., 1974). Other studies have used cross-sectional designs to compare mood symptom severity at the time of presentation in bipolar subjects who reported variable amounts of recent or remote alcohol use (Salloum et al., 2002; McKowen et al., 2005), but did not track longitudinal changes in mood or drinking outcomes. In each of these cases, the study design does not allow interpretation of the temporal relationships between drinking and mood symptoms. "
[Show abstract][Hide abstract] ABSTRACT: Bipolar disorders and alcohol use disorders commonly co-occur, yet little is known about the proximal impact of bipolar symptoms on alcohol use in patients with this comorbidity. The present study examined the impact of depressive symptoms and alcohol craving on proximal alcohol use in patients with co-occurring bipolar disorder and alcohol dependence.
Data were collected during an 8-week randomized controlled trial of acamprosate for individuals with co-occurring bipolar disorder and alcohol dependence (n = 30). Depressive symptoms and alcohol craving were assessed biweekly using the Montgomery Asberg Depression Rating Scale (MADRS) and the Obsessive Compulsive Drinking Scale (OCDS), respectively. Daily alcohol use data were available via administration of the Time-line Follow-back interview at baseline and at subsequent weekly study visits. Correlational analyses and hidden Markov modeling were used to examine the prospective relationships between depressive symptoms, alcohol craving, and alcohol use.
Depressive symptoms and alcohol craving were significantly correlated with proximal (i.e., 1 week later) alcohol use across a variety of alcohol consumption summary measures. In hidden Markov models, depressive symptoms (OR = 1.3, 95% credible interval = [1.1, 1.5]) and alcohol craving (OR = 1.6, 95% credible interval = [1.4, 1.9]) significantly predicted transitioning from a light to a heavy drinking state, or remaining in a heavy drinking state.
The results from the present study suggest that depressive symptoms and alcohol craving increase proximal risk for alcohol use in individuals with co-occurring bipolar and alcohol use disorders.
Alcoholism Clinical and Experimental Research 09/2011; 36(3):490-6. DOI:10.1111/j.1530-0277.2011.01645.x · 3.21 Impact Factor
"Patients with bipolar disorder are known to suffer a considerable number of associated pathologies such as cardiovascular disease, which may manifest at earlier ages and with increased frequency than in the general population   . Among the multiple sources of cardiovascular disease risk among patients with bipolar disorder are hypertension, hyperlipidemia, diabetes, obesity, metabolic syndrome, smoking, substance use disorders, sedentary lifestyle, endothelial dysfunction and inflammation    . "
[Show abstract][Hide abstract] ABSTRACT: Trace elements may play an important role in bipolar disorders. The objective of this study is to determine serum copper and zinc, blood lead and cadmium and urine lead, cadmium and thallium concentrations in patients diagnosed with bipolar disorders and to compare these levels with those of a healthy control group.
A total of 25 patients diagnosed with bipolar disorder and 29 healthy subjects participated in this study. Serum copper and zinc concentrations were measured using flame atomic absorption spectrometry; the blood lead and cadmium concentrations were measured by electrothermal atomization atomic absorption spectrometry with Zeeman background correction; urine lead, cadmium and thallium concentrations were measured by inductively coupled plasma mass spectrometry.
Median blood and urine lead and cadmium levels were significantly higher among the bipolar patients than among the control group: Blood lead (μg/dL): patient median: 3.00 (IQR: 1.40-4.20); control median (μg/dL): 2.20 (IQR: 0.90-3.00) p=0.040. Blood cadmium (μg/L): patient median: 0.39 (IQR: 0.10-1.15); control median: 0.10 (IQR: 0.10-0.17) p<0.001. The median of cadmium (μg/L) in patients who smoked (1.20 IQR: 0.44-2.30) was higher than that in non-smokers (0.12 IQR: 0.10-0.34) p<0.001. There was a statistically significant increase (p=0.001) in zinc levels among patients in the manic phase (mean 111.28, SD: 33.36 μg/dL) with respect to the control group (mean 86.07, SD: 12.39 μg/dL).
The results suggest that there could be higher levels of some toxic trace elements in the group of patients with bipolar disorder than in the healthy control group.
Journal of Trace Elements in Medicine and Biology 01/2011; 25 Suppl 1:S78-83. DOI:10.1016/j.jtemb.2010.10.015 · 2.37 Impact Factor
"The findings are more divergent regarding rapid cycling; as some studies did [38,40,50-52] and some did not [19,29,53] find this to be more prevalent in the SUD patients. The same inconsistency is found for the prevalence of mixed episodes, some studies found this phenomenon to be more common [14,18,39,50,54] while others did not [17,47,55] in the SUD patients. "
[Show abstract][Hide abstract] ABSTRACT: There is a strong association between bipolar disorder (BD) and substance use disorder (SUD). The clinical and functional correlates of SUD in BD are still unclear and little is known about the role of excessive substance use that does not meet SUD criteria. Thus, the aims of the current study were to investigate lifetime rates of illicit substance use in BD relative to the normal population and if there are differences in clinical and functional features between BD patients with and without excessive substance use.
125 consecutively recruited BD in- and outpatients from the Oslo University Hospitals and 327 persons randomly drawn from the population in Oslo, Norway participated. Clinical and functional variables were assessed. Excessive substance use was defined as DSM-IV SUD and/or excessive use according to predefined criteria.
The rate of lifetime illicit substance use was significantly higher among patients compared to the reference population (OR = 3.03, CI = 1.9-4.8, p < .001). Patients with excessive substance use (45% of total) had poorer educational level, occupational status, GAF-scores and medication compliance, with a trend towards higher suicidality rates, compared to patients without. There were no significant group differences in current symptom levels or disease course between groups.
The percentage of patients with BD that had tried illicit substances was significantly higher than in the normal population. BD patients with excessive substance use clearly had impaired functioning, but not a worse course of illness compared to patients without excessive substance use. An assessment of substance use beyond SUD criteria in BD is clinically relevant.
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