Goldstein Benjamin I, Levitt Anthony J
Mood Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Bipolar Disord. 2008 Feb;10(1):67-78. doi: 10.1111/j.1399-5618.2008.00461.x.
Uncertainty exists regarding whether comorbid substance use disorders (SUDs) in bipolar I disorder are more prevalent among persons with versus without comorbid anxiety disorders. Moreover, the independent contribution of these comorbidities to the burden of bipolar disorder (BD) is unclear.
The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with lifetime BD (n = 1,411). Illness severity was compared across four groups based on the presence of lifetime anxiety disorders, lifetime SUDs, neither, or both. Variables included lifetime prevalence of mixed mania, prolonged mood episodes, BD-related health service utilization, and forensic history, 12-month prevalence of mania and depression, and current general mental health functioning. Diagnoses were generated using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-IV Version. Analyses were computed separately for males and females.
For females only, the lifetime prevalence of SUDs was significantly greater among those with lifetime anxiety disorders [odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.08-1.86]; this was not found among males (OR = 1.15, 95% CI = 0.79-1.68). In multiple logistic regression analyses among both males and females, anxiety disorders were significantly associated with mixed episodes, prolonged depressive episodes, 12-month prevalence of depression, BD-related health service utilization, and poorer current mental health functioning. SUDs were significantly associated with mixed episodes among females, 12-month prevalence of depression among males, and with forensic history among both males and females.
Whereas comorbid anxiety disorders appear to confer increased liability towards poor mental health functioning and greater BD-related health service utilization, comorbid SUDs are associated with positive forensic history. Early identification and treatment of these comorbid conditions are of paramount importance. Further representative prospective studies are needed.
关于双相I型障碍中合并物质使用障碍（SUDs）在合并焦虑障碍与未合并焦虑障碍的患者中是否更为普遍，目前存在不确定性。此外，这些合并症对双相情感障碍（BD）负担的独立影响尚不清楚。
使用2001 - 2002年全国酒精及相关状况流行病学调查来识别有终生双相情感障碍的受访者（n = 1411）。根据是否存在终生焦虑障碍、终生物质使用障碍、两者皆无或两者皆有，将患者分为四组，并比较疾病严重程度。变量包括混合性躁狂的终生患病率、延长的情绪发作、与双相情感障碍相关的医疗服务利用情况和法医史、躁狂和抑郁的12个月患病率以及当前的总体心理健康功能。诊断依据美国国立酒精滥用与酒精中毒研究所酒精使用障碍及相关残疾访谈表（DSM - IV版）进行。分别对男性和女性进行分析。
仅在女性中，有终生焦虑障碍的患者中物质使用障碍的终生患病率显著更高[优势比（OR）= 1.41，95%置信区间（CI）= 1.08 - 1.86]；在男性中未发现此情况（OR = 1.15，95% CI = 0.79 - 1.68）。在男性和女性的多项逻辑回归分析中，焦虑障碍与混合发作、延长的抑郁发作、抑郁的12个月患病率、与双相情感障碍相关的医疗服务利用情况以及较差的当前心理健康功能显著相关。物质使用障碍与女性的混合发作、男性抑郁的12个月患病率以及男性和女性的法医史显著相关。
合并焦虑障碍似乎会增加心理健康功能不良和双相情感障碍相关医疗服务利用增加的易感性，而合并物质使用障碍与阳性法医史相关。尽早识别和治疗这些合并症至关重要。需要进一步开展有代表性的前瞻性研究。
