Correlates of substance use disorder in bipolar disorder: a systematic review and meta-analysis

Prevalence of Dual Diagnoses among Children and Adolescents with Mental Health Conditions

BACKGROUND

The World Health Organisation defines dual diagnosis as the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder. Children and adolescents with dual diagnoses represent a significant public health burden in social and financial terms.

AIMS

The objective of the present paper is to provide a review of studies dealing with dual diagnoses and their prevalence among children and adolescents whose primary treatment involves psychiatric conditions.

METHODS

The PRISMA was used to conduct a systematic search. Articles published between January 2010 and May 2022 were searched for analysis.

RESULTS

Eight articles were eventually found eligible for the final content analysis. The analysis of the articles identified the prevalence of dual diagnoses among children and adolescents treated primarily for psychiatric conditions, the gender-specific occurrence of dual diagnoses, methods used to diagnose psychiatric and substance use disorders, types of psychiatric diagnoses involved in dual diagnoses, and prevalence differences contingent on the type of service provision as the main thematic areas. The prevalence of dual diagnoses among the target population ranged from 18.3% to 54% (mean 32.7%). Boys were more likely to experience dual diagnoses and affective disorders were the most frequent psychiatric diagnoses.

CONCLUSION

The importance of the issue and the high prevalence of dual diagnoses make it imperative that this type of research is pursued.

Attempted suicide in people with co-occurring bipolar and substance use disorders: systematic review and meta-analysis

BACKGROUND

Both individuals with bipolar (BD) and those with alcohol (AUD) and other substance (SUD) use disorders are likely to attempt suicide. Comorbidity of BD and AUD/SUD may increase the likelihood of suicide attempts. We conducted a meta-analysis to estimate the association of comorbid AUD/SUD and suicide attempts in subjects with BD in the literature to date.

METHODS

Electronic databases through January 2013 were searched. Studies reporting rates of suicide attempts in people with co-occurring BD and AUD/SUD were retrieved. Comorbid AUD and SUD and suicide attempts rates as well as demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors.

RESULTS

Twenty-nine of 222 studies assessed for eligibility met the inclusion criteria, comprising a total of 31,294 individuals with BD, of whom 6308 (20.1%) had documented suicide attempts. There were consistent findings across the studies included. As compared to controls, subjects with BD and comorbid AUD/SUD were more likely to attempt suicide. The cross-sectional association estimates showed random-effects pooled crude ORs of 1.96 (95% CI=1.56-2.47; p<0.01), 1.72 (95% CI=1.52-1.95; p<0.01), and 1.77 (95% CI=1.49-2.10; p<0.01), for combined AUD/SUD, AUD, and SUD. There was no publication bias and sensitivity analyses based on the highest quality studies confirmed core results.

LIMITATIONS

The effects of the number and the type of suicide attempts could not be investigated due to insufficient information.

CONCLUSIONS

Comorbid AUD and SUD in individuals with BD are significantly associated with suicide attempts. Individuals with this comorbidity should be targeted for intensive suicide prevention efforts.

Behavioral approach system sensitivity and risk taking interact to predict left-frontal EEG asymmetry

The Behavioral Approach System (BAS) hypersensitivity theory of bipolar disorder (BD; Alloy & Abramson, 2010; Depue & Iacono, 1989) suggests that hyperreactivity in the BAS results in the extreme fluctuations of mood characteristic of BD. In addition to risk conferred by BAS hypersensitivity, cognitive and personality variables may play a role in determining risk. We evaluated relationships among BAS sensitivity, risk taking, and an electrophysiological correlate of approach motivation, relative left-frontal electroencephalography (EEG) asymmetry. BAS sensitivity moderated the relationship between risk taking and EEG asymmetry. More specifically, individuals who were high in BAS sensitivity showed left-frontal EEG asymmetry regardless of their level of risk-taking behavior. However, among individuals who were moderate in BAS sensitivity, risk taking was positively associated with asymmetry. These findings suggest that cognitive and personality correlates of bipolar risk may evidence unique contributions to a neural measure of trait-approach motivation. Clinical implications of these findings are discussed.