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Samimi Ardestani SM, Amin-Esmaeili M, Seif P, Gudarzi SS, Rafiefarahzadi M, Semnani Y. Managing the Dual Diagnosis Dilemma of Bipolar Disorder and Substance Abuse in Clinical Settings. J Dual Diagn 2024; 20:178-187. [PMID: 38502951 DOI: 10.1080/15504263.2024.2328600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE Drug addiction is a chronic mental disorder that significantly impacts all aspects of an individual's life, and substance use disorder in patients with bipolar disorder. The objective of this study is to assess the frequency of substance abuse among patients with bipolar spectrum disorder. METHOD This cross-sectional study evaluated the frequency of bipolar spectrum disorder in patients taking methadone through various screening measures, including Mini Mental State Examination (MMSE), DSM IV criteria, Mood Disorders Questionnaire (MDQ), Goodwin and Ghaemi's criteria, and Akiskal classification for bipolar disorders. RESULTS Out of the total 197 participants in the study, 77 were identified as individuals engaging in poly-substance abuse. The investigation assessed the frequency of bipolar spectrum disorder based on various diagnostic criteria: 24% according to DSM-IV criteria, 29.9% using MDQ, 29.9% based on Ghaemi and Goodwin's criteria, and the highest rate at 48.2% when applying Akiskal's classification. CONCLUSIONS This study highlights the high frequency of bipolar disorder among individuals with substance use disorder, especially those with concomitant depression. Therefore, it is crucial to pay special attention to individuals with substance use disorder with co-existing bipolar disorder.
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Affiliation(s)
- Seyed Mehdi Samimi Ardestani
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Associate Professor of Psychiatry, Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Seif
- Postdoc Research Fellowship, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA
| | | | | | - Yousef Semnani
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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2
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Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desouza A, Nayak O, Praharaj S, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Ghosh P, Lakdawala B, Bhattacharya R. Prevalence and association of comorbid substance dependence on the course and outcome of bipolar disorder: Findings from the bipolar disorder course and outcome study from India (BiD-CoIN study). Indian J Psychiatry 2022; 64:449-456. [PMID: 36458086 PMCID: PMC9707659 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_665_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 06/16/2022] [Accepted: 07/27/2022] [Indexed: 11/05/2022] Open
Abstract
AIM To evaluate the prevalence of substance use disorder (SUD) and its association with the course and outcome of bipolar disorder (BD). MATERIALS AND METHODS A total of 773 patients with BD were recruited from 14 centers in different parts of India, and they were evaluated for the prevalence of comorbid substance dependence, course and outcome, subjective cognitive functioning, and disability. RESULTS About one-fourth (22.9%) of the participants had one or more substance dependence. In terms of specific substance of abuse, 136 (17.6%) had nicotine dependence, 80 (10.3%) patients had alcohol dependence, 13 (1.7%) had cannabis dependence, and nine (1.2%) had opioid dependence. Compared to those without comorbid substance dependence, those with a dual diagnosis (i.e., using at least one substance in a dependent pattern) were less educated, more often males, more often currently single, more often employed, had a lower number of depressive episodes per year of illness, had a higher number of manic and mixed episodes per year of illness in the first 5 years of illness, had a higher level of disability, and more often had a history of hospitalization and a history of receiving electroconvulsive therapy (ECT); also, a higher proportion of them had manic predominant polarity, more often had recurrent mania course, and were more often receiving a combination of lithium and valproate. CONCLUSION About one-fourth of BD patients have comorbid SUDs, and presence of SUD has a negative impact on the course and outcome of BD.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Chakravarty
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amitava Dan
- Department of Psychiatry, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Kaustav Chakraborty
- Department of Psychiatry, College of Medicine and J.N.M. Hospital WBUHS, Kalyani, Kolkata, West Bengal, India
| | - Rajarshi Neogi
- Department of Psychiatry, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Avinash Desouza
- Department of Psychiatry, Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai, Maharashtra, India
| | - Omkar Nayak
- Department of Psychiatry, Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai, Maharashtra, India
| | - Samir Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raman Deep
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Bathla
- Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Alka A Subramanyam
- Department of Psychiatry, Topiwala National Medical College (Nair Hospital), Mumbai, Maharashtra, India
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prosenjit Ghosh
- Department of Psychiatry, Silchar Medical College, Silchar, Assam, India
| | - Bhavesh Lakdawala
- Department of Psychiatry, Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, Gujarat, India
| | - Ranjan Bhattacharya
- Department of Psychiatry, Murshidabad Medical College and Hospital, Murshidabad, West Bengal, India
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3
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Braverman ER, Dennen CA, Gold MS, Bowirrat A, Gupta A, Baron D, Roy AK, Smith DE, Cadet JL, Blum K. Proposing a "Brain Health Checkup (BHC)" as a Global Potential "Standard of Care" to Overcome Reward Dysregulation in Primary Care Medicine: Coupling Genetic Risk Testing and Induction of "Dopamine Homeostasis". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5480. [PMID: 35564876 PMCID: PMC9099927 DOI: 10.3390/ijerph19095480] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/27/2022]
Abstract
In 2021, over 100,000 people died prematurely from opioid overdoses. Neuropsychiatric and cognitive impairments are underreported comorbidities of reward dysregulation due to genetic antecedents and epigenetic insults. Recent genome-wide association studies involving millions of subjects revealed frequent comorbidity with substance use disorder (SUD) in a sizeable meta-analysis of depression. It found significant associations with the expression of NEGR1 in the hypothalamus and DRD2 in the nucleus accumbens, among others. However, despite the rise in SUD and neuropsychiatric illness, there are currently no standard objective brain assessments being performed on a routine basis. The rationale for encouraging a standard objective Brain Health Check (BHC) is to have extensive data available to treat clinical syndromes in psychiatric patients. The BHC would consist of a group of reliable, accurate, cost-effective, objective assessments involving the following domains: Memory, Attention, Neuropsychiatry, and Neurological Imaging. Utilizing primarily PUBMED, over 36 years of virtually all the computerized and written-based assessments of Memory, Attention, Psychiatric, and Neurological imaging were reviewed, and the following assessments are recommended for use in the BHC: Central Nervous System Vital Signs (Memory), Test of Variables of Attention (Attention), Millon Clinical Multiaxial Inventory III (Neuropsychiatric), and Quantitative Electroencephalogram/P300/Evoked Potential (Neurological Imaging). Finally, we suggest continuing research into incorporating a new standard BHC coupled with qEEG/P300/Evoked Potentials and genetically guided precision induction of "dopamine homeostasis" to diagnose and treat reward dysregulation to prevent the consequences of dopamine dysregulation from being epigenetically passed on to generations of our children.
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Affiliation(s)
- Eric R. Braverman
- The Kenneth Blum Institute on Behavior & Neurogenetics, Austin, TX 78701, USA; (E.R.B.); (C.A.D.)
| | - Catherine A. Dennen
- The Kenneth Blum Institute on Behavior & Neurogenetics, Austin, TX 78701, USA; (E.R.B.); (C.A.D.)
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Department of Psychiatry, Tulane School of Medicine, New Orleans, LA 70112, USA;
| | - Abdalla Bowirrat
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Ashim Gupta
- Future Biologics, Lawrenceville, GA 30043, USA;
| | - David Baron
- Division of Addiction Research & Education, Center for Psychiatry, Medicine & Primary Care (Office of Provost), Western University Health Sciences, Pomona, CA 91766, USA;
| | - A. Kenison Roy
- Department of Psychiatry, Tulane School of Medicine, New Orleans, LA 70112, USA;
| | - David E. Smith
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA 94158, USA;
| | - Jean Lud Cadet
- The Molecular Neuropsychiatry Research Branch, NIH National Institute on Drug Abuse, Baltimore, MD 21224, USA;
| | - Kenneth Blum
- The Kenneth Blum Institute on Behavior & Neurogenetics, Austin, TX 78701, USA; (E.R.B.); (C.A.D.)
- Division of Addiction Research & Education, Center for Psychiatry, Medicine & Primary Care (Office of Provost), Western University Health Sciences, Pomona, CA 91766, USA;
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Menculini G, Steardo L, Verdolini N, Cirimbilli F, Moretti P, Tortorella A. Substance use disorders in bipolar disorders: Clinical correlates and treatment response to mood stabilizers. J Affect Disord 2022; 300:326-333. [PMID: 34990627 DOI: 10.1016/j.jad.2022.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/06/2021] [Accepted: 01/01/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Substance use disorders (SUD) in bipolar disorders (BD) present relevant impact on psychopathological features and illness course. The present study was aimed at analyzing the clinical correlates of this comorbidity. METHODS In- and outpatients suffering from BD were recruited. Socio-demographic and clinical characteristics were collected. Subjects underwent a psychopathological assessment evaluating affective temperaments and impulsiveness. The appraisal of treatment response to mood stabilizers was conducted with the Alda Scale. Bivariate analyses were used to compare subjects suffering from BD with (SUD-BD) or without comorbid SUD (nSUD-BD) (p<0.05). A logistic regression model was performed to identify specific correlates of SUD in BD. RESULTS Among the 161 included subjects, 63 (39.1%) were diagnosed with comorbid SUD. SUD-BD subjects showed younger age at onset (p = 0.003) and higher prevalence of BD type I diagnosis (BDI) (p<0.001). Furthermore, lifetime mixed features (p<0.001), psychotic symptoms (p<0.001), suicide attempts (p = 0.002), aggression (p = 0.003), antidepressant-induced manic switch (p = 0.003), and poor treatment response (p<0.001) were more frequent in the SUD-BD subgroup. At the logistic regression, SUD revealed a positive association with BD type I diagnosis (Odds Ratio (OR) 4.77, 95% CI 1.66-13.71, p = 0.004) and mixed features (OR 2.54, 95% CI 1.17-5.53, p = 0.019). LIMITATIONS The cross-sectional study design and the relatively small sample size may limit the generalizability of the findings. The retrospective evaluation of comorbid SUD could have biased the outcome assessment. CONCLUSIONS Subjects with BD and SUD are characterized by higher clinical severity and require careful assessment of treatment response.
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Affiliation(s)
| | - Luca Steardo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Norma Verdolini
- Department of Psychiatry, University of Perugia, Perugia, Italy; Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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5
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Ociskova M, Prasko J, Kantor K, Hodny F, Kasyanik P, Holubova M, Vanek J, Slepecky M, Nesnidal V, Minarikova Belohradova K. Schema Therapy for Patients with Bipolar Disorder: Theoretical Framework and Application. Neuropsychiatr Dis Treat 2022; 18:29-46. [PMID: 35023920 PMCID: PMC8747790 DOI: 10.2147/ndt.s344356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022] Open
Abstract
Bipolar disorder (BD) is a severe mood disorder characterized by episodes of depression and hypomania or mania. Despite its primarily biological roots, the onset and course of the disorder have also been related to psychosocial factors such as early adverse experiences and related maladaptive schemas. Several researchers proposed a schema therapeutic model to treat patients with BD. In this paper, we further develop the theoretical model and elaborate on seven elements that were found effective in the psychosocial interventions with individuals with BD: monitoring mood and early symptoms of relapse, recognizing and management of stressful situations and interpersonal conflicts, creating a relapse prevention plan, stabilizing the sleep/wake cycle and daily routine, encouraging the use of medication, and reducing self-stigma and substance use. Apart from that, we describe the elements of the schema work with patients who suffer from BD. Illustrative clinical cases accompany the theoretical framework. The research of the schema therapy with patients with severe mental illnesses has only recently started developing. The presented paper also aims to encourage further research in this area and highlight potentially beneficial research goals.
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Affiliation(s)
- Marie Ociskova
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic.,Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic
| | - Krystof Kantor
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | | | - Michaela Holubova
- Department of Pedagogy and Psychology, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, The Czech Republic.,Department of Psychiatry, Regional Hospital Liberec, Liberec, The Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Vlastimil Nesnidal
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Kamila Minarikova Belohradova
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
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6
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Icick R, Melle I, Etain B, Høegh MC, Gard S, Aminoff SR, Leboyer M, Andreassen OA, Belzeaux R, Henry C, Bjella TD, Kahn JP, Steen NE, Bellivier F, Lagerberg TV. Preventive Medication Patterns in Bipolar Disorder and Their Relationship With Comorbid Substance Use Disorders in a Cross-National Observational Study. Front Psychiatry 2022; 13:813256. [PMID: 35592382 PMCID: PMC9110763 DOI: 10.3389/fpsyt.2022.813256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The potential role of sub-optimal pharmacological treatment in the poorer outcomes observed in bipolar disorder (BD) with vs. without comorbid substance use disorders (SUDs) is not known. Thus, we investigated whether patients with BD and comorbid SUD had different medication regimens than those with BD alone, in samples from France and Norway, focusing on compliance to international guidelines. METHODS Seven hundred and seventy patients from France and Norway with reliably ascertained BD I or II (68% BD-I) were included. Medication information was obtained from patients and hospital records, and preventive treatment was categorized according to compliance to guidelines. We used Bayesian and regression analyses to investigate associations between SUD comorbidity and medication. In the Norwegian subsample, we also investigated association with lack of medication. RESULTS Comorbid SUDs were as follows: current tobacco smoking, 26%, alcohol use disorder (AUD), 16%; cannabis use disorder (CUD), 10%; other SUDs, 5%. Compliance to guidelines for preventive medication was lacking in 8%, partial in 44%, and complete in 48% of the sample. Compliance to guidelines was not different in BD with and without SUD comorbidity, as was supported by Bayesian analyses (highest Bayes Factor = 0.16). Cross national differences in treatment regimens led us to conduct country-specific adjusted regression analyses, showing that (1) CUD was associated with increased antipsychotics use in France (OR = 2.4, 95% CI = 1.4-3.9, p = 0.001), (2) current tobacco smoking was associated with increased anti-epileptics use in Norway (OR = 4.4, 95% CI = 1.9-11, p < 0.001), and (3) AUD was associated with decreased likelihood of being medicated in Norway (OR = 1.2, 95% CI = 1.04-1.3, p = 0.038). CONCLUSION SUD comorbidity in BD was overall not associated with different pharmacological treatment in our sample, and not related to the level of compliance to guidelines. We found country-specific associations between comorbid SUDs and specific medications that warrant further studies.
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Affiliation(s)
- Romain Icick
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,FondaMental Foundation, Créteil, France.,INSERM U1144, Université Paris Cité, Paris, France
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bruno Etain
- FondaMental Foundation, Créteil, France.,INSERM U1144, Université Paris Cité, Paris, France.,Université Paris Cité, Paris, France.,Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris, France
| | - Margrethe Collier Høegh
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sébastien Gard
- INSERM U1144, Université Paris Cité, Paris, France.,Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Pôle de Psychiatrie Générale et Universitaire (3/4/7), Bordeaux, France
| | - Sofie R Aminoff
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Marion Leboyer
- FondaMental Foundation, Créteil, France.,Paris Est Créteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), HU Henri Mondor, Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Fédération Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Créteil, France
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Raoul Belzeaux
- Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital Sainte-Marguerite, Pôle de Psychiatrie, INT-UMR 7289, CNRS, Aix-Marseille University, Marseille, France
| | - Chantal Henry
- Université Paris Cité, Paris, France.,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Thomas D Bjella
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jean-Pierre Kahn
- Université de Lorraine, CHRU de Nancy et Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, Laxou, France
| | - Nils Eiel Steen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Frank Bellivier
- FondaMental Foundation, Créteil, France.,INSERM U1144, Université Paris Cité, Paris, France.,Université Paris Cité, Paris, France.,Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris, France
| | - Trine Vik Lagerberg
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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7
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Icick R, Gard S, M'Bailara K, Biseul I, Samalin L, Brousse G, Flaudias V, Llorca PM, Loftus J, Cussac I, Aubin V, Schwan R, Roux P, Polosan M, Courtet P, Olié E, Henry C, Mazer N, Haffen E, Etain B, Leboyer M, Bellivier F, Belzeaux R, Godin O, Guillaume S. The course of bipolar disorder as a function of the presence and sequence of onset of comorbid alcohol use disorders in outpatients attending the Fondamental Advanced Centres of Expertise. J Affect Disord 2021; 287:196-203. [PMID: 33799038 DOI: 10.1016/j.jad.2021.03.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The comorbidity of alcohol use disorder (AUD) and bipolar disorder (BD) has been repeatedly associated with poorer clinical outcomes than BD without AUD. We aimed to extend these findings by focusing on the characteristics associated with the sequence of onset of BD and AUD. METHODS 3,027 outpatients from the Fondamental Advanced Centres of Expertise were ascertained for BD-1, BD-2 and AUD diagnoses, including their respective ages at onset (AAOs, N =2,804). We selected the variables associated with both the presence and sequence of onset of comorbid AUD using bivariate analyses corrected for multiple testing to enter a binary regression model with the sequence of onset of BD and AUD as the dependent variable (AUD first - which also included 88 same-year onsets, vs. BD first). RESULTS BD patients with comorbid AUD showed more severe clinical profile than those without. Compared to BD-AUD (N =269), AUD-BD (N =276) was independently associated with a higher AAO of BD (OR =1.1, p <0.001), increased prevalence of comorbid cannabis use disorder (OR =2.8, p <0.001) a higher number of (hypo)manic/mixed BD episodes per year of bipolar illness (OR =3, p <0.01). LIMITATIONS The transversal design prevents from drawing causal conclusions. CONCLUSION Increased severity of BD with AUD compared to BD alone did not differ according to the sequence of onset. A few differences, though, could be used to better monitor the trajectory of patients showing either one of these disorders.
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Affiliation(s)
- Romain Icick
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, DMU Neurosciences, Département de psychiatrie et de Médecine Addictologique, Paris, France. Fédération Hospitalo-Universitaire 'FHU NOR-SUD'.; Université de Paris, UMR-S 1144, Paris, France.
| | - Sébastien Gard
- Fondation Fondamental, Créteil, France; Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Pôle de Psychiatrie Générale et Universitaire (3/4/7), Bordeaux, France
| | - Katia M'Bailara
- Fondation Fondamental, Créteil, France; Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Pôle de Psychiatrie Générale et Universitaire (3/4/7), Bordeaux, France
| | - Isabelle Biseul
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, DMU Neurosciences, Département de psychiatrie et de Médecine Addictologique, Paris, France. Fédération Hospitalo-Universitaire 'FHU NOR-SUD'
| | - Ludovic Samalin
- Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France
| | - Georges Brousse
- Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France
| | - Valentin Flaudias
- Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France
| | - Joséphine Loftus
- Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco
| | - Iréna Cussac
- Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco
| | - Valérie Aubin
- Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco
| | - Raymund Schwan
- Université de Lorraine, Inserm U1114, Centre Psychothérapique de Nancy, Nancy, France
| | - Paul Roux
- Fondation Fondamental, Créteil, France; Service Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, Le Chesnay, Université Paris-Saclay, UVSQ, Inserm, CESP, Team "DevPsy", 94807, Villejuif, France
| | - Mircea Polosan
- Fondation Fondamental, Créteil, France; Université Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U 1216, Grenoble, France
| | - Philippe Courtet
- Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; PSNREC, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Emilie Olié
- Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; PSNREC, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Chantal Henry
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, F-75014, Paris, France
| | - Nicolas Mazer
- Fondation Fondamental, Créteil, France; AP-HP, Groupe Hospitalo-universitaire Nord, DMU ESPRIT, service de Psychiatrie et Addictologie. Hopital Louis Mourier, Colombes, Inserm U1266, Faculté de médecine, Université de Paris, France
| | - Emmanuel Haffen
- Fondation Fondamental, Créteil, France; Service de Psychiatrie de l'Adulte, Centres Experts FondaMental, Centre Investigation Clinique 1431-INSERM, EA 481 Neurosciences, Université de Franche Comté, Besançon, France
| | - Bruno Etain
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, DMU Neurosciences, Département de psychiatrie et de Médecine Addictologique, Paris, France. Fédération Hospitalo-Universitaire 'FHU NOR-SUD'.; Université de Paris, UMR-S 1144, Paris, France
| | - Marion Leboyer
- Fondation Fondamental, Créteil, France; Université Paris Est Créteil, Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010, Créteil, France - AP-HP, HU Henri Mondor, Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Fédération Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT) F-94010, France
| | - Frank Bellivier
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, DMU Neurosciences, Département de psychiatrie et de Médecine Addictologique, Paris, France. Fédération Hospitalo-Universitaire 'FHU NOR-SUD'.; Université de Paris, UMR-S 1144, Paris, France
| | - Raoul Belzeaux
- Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France, INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Ophélia Godin
- Fondation Fondamental, Créteil, France; Université Paris Est Créteil, Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010, Créteil, France - AP-HP, HU Henri Mondor, Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Fédération Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT) F-94010, France
| | - Sébastien Guillaume
- Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; PSNREC, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
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Crowe M, Eggleston K, Douglas K, Porter RJ. Effects of psychotherapy on comorbid bipolar disorder and substance use disorder: A systematic review. Bipolar Disord 2021; 23:141-151. [PMID: 32615028 DOI: 10.1111/bdi.12971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This review aim was to examine whether psychotherapy is more or less effective in patients with SUD, compared to those without; whether there is a differential effect of a particular psychotherapy in patients with SUD. METHODS A quantitative systematic review following the Cochrane Handbook of Systematic Reviews was used. RESULTS Five studies of psychotherapy for BD and two studies of an integrated psychotherapy for comorbid BD and SUD were included in the review. Five studies provided a sub-analysis of the effect of SUD on overall outcomes with only one finding an overall detrimental effect. The results indicated equal, if not better outcomes for individuals with comorbid BD and SUD. CONCLUSION There was little evidence that interventions targeted at both BD and SUD may be more efficacious. Further research in to psychotherapeutic treatment for BD should include individuals with comorbid SUD, and analyse substance use as an outcome. Additionally, research into treatments specifically developed for these commonly comorbid disorders is indicated.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Moot W, Crowe M, Inder M, Eggleston K, Frampton C, Porter R. Functional and Mood Outcomes in Bipolar Disorder Patients With and Without Substance Use Disorders Undergoing Psychotherapy. Front Psychiatry 2021; 12:661458. [PMID: 34594244 PMCID: PMC8477031 DOI: 10.3389/fpsyt.2021.661458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: Research suggests that patients with co-morbid bipolar disorder (BD) and substance use disorder (SUD) have a poorer illness course and clinical outcome. The evidence is limited as SUD patients are often excluded from BD studies. In particular, evidence regarding long term outcomes from studies using psychotherapies as an adjunctive treatment is limited. We therefore examined data from two studies of Interpersonal Social Rhythm Therapy (IPSRT) for BD to determine whether lifetime or current SUD affected outcomes. Methods: Data were analyzed from two previous clinical trials of IPSRT for BD patients. Change in scores on the Social Adjustment Scale (SAS) from 0 to 78 weeks and cumulative mood scores from 0 to 78 weeks, measured using the Life Interval Follow-Up Evaluation (LIFE), were analyzed. Results: Of 122 patients (non-SUD n = 67, lifetime SUD but no current n = 43, current SUD n = 12), 79 received IPSRT and 43 received a comparison therapy-specialist supportive care-over 18 months. Lifetime SUD had a significant negative effect on change in SAS score but not LIFE score. There was no effect of current SUD on either change in score. Secondary analysis showed no correlation between symptom count and change in SAS total score or LIFE score. Conclusion: Current SUD has no impact on mood or functional outcomes, however, current SUD numbers were small, limiting conclusions. Lifetime SUD appears to be associated with impaired functional outcomes from psychotherapy. There is limited research on co-morbid BD and SUD patients undergoing psychotherapy.
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Affiliation(s)
- William Moot
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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