Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
J Affect Disord. 2012 Dec 15;142(1-3):57-64. doi: 10.1016/j.jad.2012.04.010. Epub 2012 Sep 7.
There is a paucity of longitudinal data characterizing the relationship between substance use disorder (SUD) and the early clinical course of bipolar disorder (BD). We studied this relationship in a prospectively assessed cohort of high-risk offspring.
Eligible families had one parent with confirmed BD based on SADS-L interviews and best estimate diagnostic procedure. Offspring completed KSADS-PL interviews at baseline and were reassessed prospectively. DSM-IV diagnoses were made on blind consensus review using all available information. This analysis included 211 offspring ≥12 years, and used GEE and linear mixed models to determine clinical characteristics differentiating those with compared to those without SUD, and CPH models to assess the relationship between SUD and the early stages of BD.
Lifetime SUD was diagnosed in 24% of offspring; cannabis use being most common. The peak hazard of SUD was between 14 and 20 years of age. Male sex (HR 3.285; p=.0007), a prior mood disorder (HR 2.437; p=.0091) and parental history of SUD (HR 2.999; p=.0027) contributed to the risk of SUD in the offspring, while SUD predicted an increased risk of psychosis (HR 3.225; p=.0074). The estimated hazard of a major mood disorder in those offspring with compared to those without a prior SUD was almost 3-fold (HR 2.990 (p≤0.01).
The novel clinical staging model requires independent replication.
SUD is a common comorbidity arising during the early course of BD, even before the first activated episode. Further research is needed to understand causative factors and to develop effective early intervention and prevention strategies.
目前缺乏纵向数据来描述物质使用障碍（SUD）与双相情感障碍（BD）早期临床病程之间的关系。我们在一个经过前瞻性评估的高危后代队列中研究了这种关系。
符合条件的家庭有一位经 SADS-L 访谈和最佳估计诊断程序确诊的 BD 父母。后代在基线时完成 KSADS-PL 访谈，并进行前瞻性重新评估。使用所有可用信息进行盲共识审查，以确定 DSM-IV 诊断。该分析包括 211 名≥12 岁的后代，使用 GEE 和线性混合模型确定区分有 SUD 和无 SUD 的临床特征，使用 CPH 模型评估 SUD 与 BD 早期之间的关系。
24%的后代被诊断为终生 SUD；大麻使用最常见。SUD 的高峰危险发生在 14 至 20 岁之间。男性（HR 3.285；p=.0007）、先前的心境障碍（HR 2.437；p=.0091）和父母 SUD 史（HR 2.999；p=.0027）增加了后代发生 SUD 的风险，而 SUD 预测精神病风险增加（HR 3.225；p=.0074）。与无 SUD 病史的后代相比，有 SUD 病史的后代发生重大心境障碍的估计风险几乎增加了 3 倍（HR 2.990（p≤0.01）。
新的临床分期模型需要独立验证。
SUD 是 BD 早期发病过程中常见的共病，甚至在首次激活发作之前就已出现。需要进一步研究以了解因果因素，并制定有效的早期干预和预防策略。
