Department of Psychiatry, EMGO Institute for Health and Care Research, Vrije Universiteit, University Medical Center Amsterdam, Bennebroek, Amsterdam, The Netherlands.
J Clin Psychiatry. 2010 Jul;71(7):885-93. doi: 10.4088/JCP.09m05079gry. Epub 2010 Jan 26.
Comorbid alcohol use disorders (AUDs) are frequently associated with negative effects on course and outcome of bipolar disorder. This prospective cohort study assessed the effect of actual alcohol use (no, moderate, and excessive) on the course and outcome of patients with bipolar disorders.
Between June 2003 and November 2005, 137 outpatients (aged 23-68 years) with DSM-IV-diagnosed bipolar I (66%) or II (34%) disorder rated their mood and the number of alcohol units consumed daily for a period up to 52 weeks with the National Institute of Mental Health Self-Rating Prospective Life-Chart Method (LCM). At baseline, the Structured Clinical Interview for DSM-IV was administrated, and demographic, social, and clinical characteristics were obtained. At monthly visits, the Clinical Global Impressions Scale-Bipolar Version (CGI-BP), the Global Assessment of Functioning (GAF) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS-SF-36) were rated. Based on the alcohol use in the first 4 weeks of follow-up, patients were assigned to 1 of 3 groups: no/incidental, moderate, or excessive alcohol use.
None of the sociodemographic and clinical characteristics at baseline were significantly different between the 3 drinking groups, with the exception of-and as a consequence of the group assignment-the prevalence of lifetime and current diagnosis of AUD. Also, no differences between the 3 drinking groups were found on any of the clinical outcome variables, ie, number of days ill (depressed, hypomanic/manic, and total); severity of depression, mania, and overall bipolar illness (LCM); GAF score; CGI-BP (depression, mania, and overall); and all the subscales of the MOS-SF-36. Also, the number of episodes according to DSM-IV and the Leapfrog method showed no significant differences between the drinking groups.
In this sample of patients and with the sensitive measurement of mood and drinking status over a full year, we could not confirm the findings of other studies indicating a negative effect of excessive alcohol use on the course of bipolar illness. This study found that neither moderate nor excessive use of alcohol has a negative effect on the course and outcome of bipolar illness. Possible explanations for these findings are discussed.
共病酒精使用障碍（AUD）常与双相情感障碍的病程和结局的负面后果相关。本前瞻性队列研究评估了实际饮酒（无、中度和过量）对双相情感障碍患者病程和结局的影响。
2003 年 6 月至 2005 年 11 月期间，137 名（年龄 23-68 岁）符合 DSM-IV 诊断的双相 I 型（66%）或 II 型（34%）障碍的门诊患者使用国家精神卫生研究所自我评定前瞻性生命图表法（LCM）评定了他们的情绪和每天饮酒的酒精单位数，为期长达 52 周。在基线时，进行了 DSM-IV 结构化临床访谈，并获得了人口统计学、社会和临床特征。在每月的就诊中，评定了临床总体印象量表-双相版（CGI-BP）、总体功能评估（GAF）量表和医疗结局研究 36 项简短健康调查问卷（MOS-SF-36）。基于随访的前 4 周的饮酒情况，将患者分为 3 组之一：无/偶发饮酒、中度饮酒或过量饮酒。
除了（并且是由于分组）终生和当前 AUD 诊断的患病率外，基线时的任何社会人口学和临床特征在 3 个饮酒组之间均无显著差异。此外，在任何临床结局变量上，3 个饮酒组之间也没有差异，例如患病天数（抑郁、轻躁狂/躁狂和总）；抑郁、躁狂和总体双相情感障碍的严重程度（LCM）；GAF 评分；CGI-BP（抑郁、躁狂和总体）；以及 MOS-SF-36 的所有子量表。根据 DSM-IV 和 Leapfrog 方法，发作次数也没有在饮酒组之间显示出显著差异。
在本患者样本中，使用敏感的情绪和饮酒状态测量方法进行了为期一年的测量，我们无法证实其他研究的发现，即过量饮酒对双相情感障碍病程有负面影响。本研究发现，中度或过量饮酒均不会对双相情感障碍的病程和结局产生负面影响。对这些发现的可能解释进行了讨论。
