Janiri Delfina, Di Nicola Marco, Martinotti Giovanni, Janiri Luigi
NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy.
Curr Neuropharmacol. 2017 Apr;15(3):409-416. doi: 10.2174/1570159X14666160607101400.
Predominant polarity characterises patients who mainly manifest recurrences of depression or mania/hypomania. Alcohol use disorder (AUD) and polysubstance use (PSU), which often complicate bipolar disorder (BD) and affect its clinical course, can influence predominant polarity. Nevertheless, previous studies have not clarified if BD patients differ in predominant polarity from BD patients with substance use disorder (SUD) comorbidity.
The aim of this study was to compare predominant polarity between BD without SUD, BD with AUD and BD with PSU. We also investigated the association between predominant polarity and first episode polarity in each diagnostic group.
We evaluated predominant polarity (≥2:1 lifetime depressive vs. manic/hypomanic episodes) in 218 DSM-IV-TR BD patients. Specifically, data were obtained from 86 patients with BD without SUD, 69 patients with BD and AUD, and 63 patients with BD and PSU with alcohol as the primary substance abused.
The three groups significantly differed for predominant polarity. The most common predominant polarity in BD without SUD was manic, while in BD with AUD and in BD with PSU it was depressive. Uncertain predominant polarity was the least common in BD without SUD and BD with PSU, whereas in BD with AUD, manic predominant polarity was least common. Predominant polarity matched onset polarity in all groups.
BD without SUD, BD with AUD, and BD with PSU have different predominant polarities. The correspondence between predominant polarity and polarity at the onset may impact diagnosis and treatment of BD.
主导极性特征描述的是主要表现为抑郁或躁狂/轻躁狂复发的患者。酒精使用障碍（AUD）和多物质使用（PSU）常使双相情感障碍（BD）复杂化并影响其临床病程，可能影响主导极性。然而，既往研究尚未阐明BD患者与合并物质使用障碍（SUD）的BD患者在主导极性上是否存在差异。
本研究旨在比较无SUD的BD、合并AUD的BD和合并PSU的BD之间的主导极性。我们还研究了每个诊断组中主导极性与首次发作极性之间的关联。
我们评估了218例DSM-IV-TR双相情感障碍患者的主导极性（终生抑郁发作与躁狂/轻躁狂发作比例≥2:1）。具体而言，数据来自86例无SUD的BD患者、69例合并BD和AUD的患者以及63例以酒精为主要滥用物质的合并BD和PSU的患者。
三组在主导极性上有显著差异。无SUD的BD中最常见的主导极性是躁狂，而在合并AUD的BD和合并PSU的BD中是抑郁。不确定的主导极性在无SUD的BD和合并PSU的BD中最不常见，而在合并AUD的BD中，躁狂主导极性最不常见。所有组中主导极性与起病极性相符。
无SUD的BD、合并AUD的BD和合并PSU的BD具有不同的主导极性。主导极性与起病时极性的对应关系可能影响双相情感障碍的诊断和治疗。
