Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine; Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, University of Toronto.
J Am Acad Child Adolesc Psychiatry. 2013 Oct;52(10):1026-37. doi: 10.1016/j.jaac.2013.07.009. Epub 2013 Jul 31.
Substance use disorders (SUD) are common and problematic in bipolar disorder (BP). We prospectively examined predictors of first-onset SUD among adolescents with BP.
Adolescents (12-17 years old; N = 167) in the Course and Outcome of Bipolar Youth (COBY) study fulfilling criteria for BP-I, BP-II, or operationalized BP not otherwise specified, without SUD at intake, were included. Baseline demographic, clinical, and family history variables, and clinical variables assessed during follow-up, were examined in relation to first-onset SUD. Participants were prospectively interviewed every 38.5 ± 22.2 weeks for an average of 4.25 ± 2.11 years.
First-onset SUD developed among 32% of subjects, after a mean of 2.7 ± 2.0 years from intake. Lifetime alcohol experimentation at intake most robustly predicted first-onset SUD. Lifetime oppositional defiant disorder and panic disorder, family history of SUD, low family cohesiveness, and absence of antidepressant treatment at intake were also associated with increased risk of SUD, whereas BP subtype was not. Risk of SUD increased with increasing number of these 6 predictors: 54.7% of subjects with 3 or more predictors developed SUD vs. 14.1% of those with fewer than 3 predictors (hazard ratio = 5.41 95% confidence interval = 2.7-11.0 p < .0001). Greater hypo/manic symptom severity in the preceding 12 weeks predicted greater likelihood of SUD onset. Lithium exposure in the preceding 12 weeks predicted lower likelihood of SUD.
This study identifies several predictors of first-onset SUD in the COBY sample that, if replicated, may suggest targets for preventive interventions for SUD among youth with BP. Treatment-related findings are inconclusive and must be interpreted tentatively, given the limitations of observational naturalistic treatment data. There is a substantial window of opportunity between BP and SUD onset during which preventive strategies may be used.
物质使用障碍（SUD）在双相障碍（BP）中很常见且成问题。我们前瞻性地研究了青少年首发 SUD 的预测因素。
符合 BP-I、BP-II 或操作性 BP 但无 SUD 的青少年（12-17 岁；N=167）纳入了 Course and Outcome of Bipolar Youth（COBY）研究。在随访期间评估基线人口统计学、临床和家族史变量以及临床变量与首发 SUD 的关系。参与者每 38.5±22.2 周接受一次前瞻性访谈，平均随访 4.25±2.11 年。
首发 SUD 在 32%的受试者中发展，从入组到入组后 2.7±2.0 年。入组时的终生酒精试验最能预测首发 SUD。入组时的终生对立违抗障碍和惊恐障碍、SUD 的家族史、低家庭凝聚力以及入组时无抗抑郁治疗也与 SUD 风险增加相关，而 BP 亚型则无。SUD 的风险随着这 6 个预测因素的数量增加而增加：3 个或更多预测因素的受试者中，有 54.7%发生 SUD，而预测因素少于 3 个的受试者中，有 14.1%发生 SUD（风险比=5.41，95%置信区间=2.7-11.0，p<.0001）。入组前 12 周的低/躁狂症状严重程度预测 SUD 发病的可能性更大。入组前 12 周的锂暴露预测 SUD 的可能性较低。
这项研究确定了 COBY 样本中首发 SUD 的几个预测因素，如果得到复制，可能会提示针对 BP 青少年 SUD 的预防干预目标。鉴于观察性自然治疗数据的局限性，治疗相关发现尚不确定，必须谨慎解释。在 BP 和 SUD 发病之间存在一个很大的机会窗口，可以在此期间使用预防策略。
