Wilens Timothy E, Biederman Joseph, Martelon MaryKate, Zulauf Courtney, Anderson Jesse P, Carrellas Nicholas W, Yule Amy, Wozniak Janet, Fried Ronna, Faraone Stephen V
Pediatric Psychopharmacology, Massachusetts General Hospital, 55 Fruit St, YAW 6A, Boston, MA 02114.
Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Clin Psychiatry. 2016 Oct;77(10):1420-1427. doi: 10.4088/JCP.14m09440.
Bipolar disorder (BPD) is a highly morbid disorder increasingly recognized in adolescents. The aim of this study was to examine the relative risk for substance use disorders (SUDs; alcohol or drug abuse or dependence) and cigarette smoking in adolescents with BPD.
We evaluated the relative risk for SUDs and cigarette smoking in a case-controlled, 5-year prospective follow-up of adolescents with (n = 105, mean ± SD baseline age = 13.6 ± 2.5 years) and without ("controls"; n = 98, baseline age = 13.7 ± 2.1 years) BPD. Seventy-three percent of subjects were retained at follow-up (BPD: n = 68; controls: n = 81; 73% reascertainment). Our main outcomes were assessed by blinded structured interviews for DSM-IV criteria.
Maturing adolescents with BPD, compared to controls, were more likely to endorse higher rates of SUD (49% vs 26%; hazard ratio [HR] = 2.0; 95% confidence interval (CI), 1.1-3.6; P = .02) and cigarette smoking (49% vs 17%; HR = 2.9; 95% CI, 1.4-6.1; P = .004), as well as earlier onset of SUD (14.9 ± 2.6 [SD] years vs 16.5 ± 1.6 [SD] years; t = 2.6; P = .01). Subjects with conduct disorder (CD) were more likely to have SUD and nicotine dependence than subjects with BPD alone or controls (all P values < .05). When we added conduct disorder to the model with socioeconomic status and parental SUD, all associations lost significance (all P values > .05). Subjects with the persistence of a BPD diagnosis were also more likely to endorse cigarette smoking and SUD in comparison to those who lost a BPD diagnosis or controls at follow-up.
The results provide further evidence that adolescents with BPD, particularly those with comorbid CD, are significantly more likely to endorse cigarette smoking and SUDs when compared to their non-mood disordered peers. These findings indicate that youth with BPD should be carefully monitored for comorbid CD and the development of cigarette smoking and SUDs.
双相情感障碍（BPD）是一种在青少年中日益被认识到的高发性疾病。本研究的目的是检验患有BPD的青少年发生物质使用障碍（SUDs；酒精或药物滥用或依赖）和吸烟的相对风险。
我们在一项病例对照的5年前瞻性随访研究中，评估了患有BPD（n = 105，平均±标准差基线年龄 = 13.6 ± 2.5岁）和未患BPD（“对照组”；n = 98，基线年龄 = 13.7 ± 2.1岁）的青少年发生SUDs和吸烟的相对风险。73%的受试者在随访时被保留（BPD组：n = 68；对照组：n = 81；重新确定率73%）。我们的主要结局通过对DSM-IV标准进行盲法结构化访谈来评估。
与对照组相比，患有BPD的青少年更有可能认可更高的SUD发生率（49%对26%；风险比[HR] = 2.0；95%置信区间[CI]，1.1 - 3.6；P = .02）和吸烟率（49%对17%；HR = 2.9；95% CI，1.4 - 6.1；P = .004），以及更早开始使用物质（14.9 ± 2.6[标准差]岁对16.5 ± 1.6[标准差]岁；t = 2.6；P = .01）。患有品行障碍（CD）的受试者比仅患有BPD的受试者或对照组更有可能发生SUD和尼古丁依赖（所有P值 < .05）。当我们将品行障碍添加到包含社会经济地位和父母SUD的模型中时，所有关联均失去显著性（所有P值 > .05）。与在随访时失去BPD诊断的受试者或对照组相比，持续患有BPD诊断的受试者也更有可能认可吸烟和SUD。
结果提供了进一步的证据，表明与非情绪障碍的同龄人相比，患有BPD的青少年，尤其是那些合并CD的青少年，更有可能认可吸烟和SUDs。这些发现表明，对于患有BPD的青少年，应仔细监测其合并的CD以及吸烟和SUDs 的发展情况。
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