Department of Psychiatry, Bipolar Disorder Research Center at Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
Am J Addict. 2010 Sep-Oct;19(5):440-9. doi: 10.1111/j.1521-0391.2010.00060.x.
We set out to study independent predictor(s) for lifetime and recent substance use disorders (SUDs) in patients with rapid-cycling bipolar disorder (RCBD). Extensive Clinical Interview and Mini-International Neuropsychiatric Interview were used to ascertain DSM-IV Axis I diagnoses of RCBD, anxiety disorders, and SUDs. Data from patients enrolling into four similar clinical trials were used. Where appropriate, univariate analyses with t-test or chi-square were applied. Stepwise logistic regression was used to examine the relationship among predictor variables and lifetime and recent SUDs. Univariate analysis showed that patients with co-occurring anxiety disorders (n = 261) had significantly increased rates of lifetime (odds ratio [OR]= 2.1) and recent (OR = 1.9) alcohol dependence as well as lifetime (OR = 3.4) and recent (OR = 2.5) marijuana dependence compared to those without co-occurring anxiety disorder (n = 303). In logistic regression analyses, generalized anxiety disorder (GAD) was associated with increased risk for lifetime SUDs (OR = 2.34), alcohol dependence (OR = 1.73), and marijuana dependence (OR = 3.36) and recent marijuana dependence (OR = 3.28). A history of physical abuse was associated with increased risk for lifetime SUDs (OR = 1.71) and recent marijuana dependence (OR = 3.47). Earlier onset of first mania/hypomania was associated with increased risk for lifetime SUDs (5% per year), and recent marijuana dependence (12% per year) and later treatment with a mood stabilizer were also associated with increased risk for recent SUDs (8% per year). Positive associations between GAD, later treatment with a mood stabilizer, and early childhood trauma and history of SUDs suggest that adequate treatment of comorbid anxiety, early treatment with a mood stabilizer, and prevention of childhood trauma may reduce the risk for the development of SUDs in patients with bipolar disorder.
我们着手研究快速循环型双相障碍（RCBD）患者一生中及近期物质使用障碍（SUD）的独立预测因子。采用广泛的临床访谈和迷你国际神经精神访谈，以确定 DSM-IV 轴 I 诊断的 RCBD、焦虑障碍和 SUD。使用了参加四项类似临床试验的患者的数据。在适当的情况下，采用 t 检验或卡方检验进行单变量分析。逐步逻辑回归用于检查预测变量与终生和近期 SUD 之间的关系。单变量分析显示，共患焦虑障碍的患者（n=261）与不共患焦虑障碍的患者（n=303）相比，终生（比值比[OR]=2.1）和近期（OR=1.9）酒精依赖以及终生（OR=3.4）和近期（OR=2.5）大麻依赖的发生率显著升高。在逻辑回归分析中，广泛性焦虑症（GAD）与终生 SUD 风险增加相关（OR=2.34）、酒精依赖（OR=1.73）、大麻依赖（OR=3.36）和近期大麻依赖（OR=3.28）。既往躯体虐待史与终生 SUD 风险增加相关（OR=1.71）和近期大麻依赖（OR=3.47）。首次躁狂/轻躁狂发作的年龄较早与终生 SUD 风险增加相关（每年增加 5%），近期使用心境稳定剂治疗较晚也与近期 SUD 风险增加相关（每年增加 8%）。GAD、较晚使用心境稳定剂、儿童期创伤和 SUD 史之间的阳性关联表明，充分治疗共病焦虑症、早期使用心境稳定剂和预防儿童期创伤可能会降低双相障碍患者发生 SUD 的风险。
