Preuss Ulrich W, Hesselbrock M N, Hesselbrock V M
Vitos Hospital Psychiatry and Psychotherapy, Herborn, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics, Martin Luther-University Halle-Wittenberg, Halle, Germany.
Front Psychiatry. 2020 Dec 21;11:522228. doi: 10.3389/fpsyt.2020.522228. eCollection 2020.
Comorbidity of alcohol use disorders in bipolar subjects is high as indicated by epidemiological and clinical studies. Though a more severe course of bipolar disorder in subjects with comorbid alcohol dependence has been reported, fewer studies considered the longitudinal course of alcohol dependence in bipolar subjects and the prospective course of comorbid bipolar II subjects. Beside baseline analysis, longitudinal data of the COGA (Collaborative Study on Genetics in Alcoholism) were used to evaluate the course of bipolar I and II disordered subjects with and without comorbid alcohol dependence over more than 5 years of follow-up. Characteristics of bipolar disorder, alcohol dependence and comorbid psychiatric disorders were assessed using semi-structured interviews (SSAGA) at baseline and at a 5-year follow-up. Two hundred twenty-eight bipolar I and II patients were subdivided into groups with and without comorbid alcohol dependence. Of the 152 bipolar I and 76 bipolar II patients, 172 (75, 4%) had a comorbid diagnosis of alcohol dependence. Bipolar I patients with alcohol dependence, in particular women, had a more severe course of bipolar disorder, worse social functioning and more suicidal behavior than all other groups of subjects during the 5-year follow-up. In contrast, alcohol dependence improved significantly in both comorbid bipolar I and II individuals during this time. A 5-year prospective evaluation of bipolar patients with and without alcohol dependence confirmed previous investigations suggesting a more severe course of bipolar disorder in comorbid bipolar I individuals, whereas bipolar II individuals were less severely impaired by comorbid alcohol use disorder. While severity of alcohol dependence improved during this time in comorbid alcohol-dependent bipolar I patients, the unfavorable outcome for these individuals might be due to the higher comorbidity with personality and other substance use disorders which, together with alcohol dependence, eventually lead to poorer symptomatic and functional clinical outcomes.
流行病学和临床研究表明，双相情感障碍患者中酒精使用障碍的共病率很高。尽管已有报道称，患有酒精依赖共病的双相情感障碍患者病情更为严重，但较少有研究考虑双相情感障碍患者中酒精依赖的纵向病程以及双相II型共病患者的前瞻性病程。除了基线分析外，酒精中毒遗传学合作研究（COGA）的纵向数据还用于评估在超过5年的随访中，伴有和不伴有酒精依赖共病的双相I型和II型障碍患者的病程。在基线和5年随访时，使用半结构化访谈（SSAGA）评估双相情感障碍、酒精依赖和共病精神障碍的特征。228例双相I型和II型患者被分为伴有和不伴有酒精依赖共病的组。在152例双相I型患者和76例双相II型患者中，172例（75.4%）有酒精依赖的共病诊断。在5年随访期间，伴有酒精依赖的双相I型患者，尤其是女性，其双相情感障碍病程更严重，社会功能更差，自杀行为更多。相比之下，在此期间，伴有酒精依赖共病的双相I型和II型患者的酒精依赖均有显著改善。对伴有和不伴有酒精依赖的双相情感障碍患者进行的5年前瞻性评估证实了先前的研究结果，即伴有酒精依赖共病的双相I型患者双相情感障碍病程更严重，而双相II型患者受酒精使用障碍共病的影响较小。虽然在此期间，伴有酒精依赖共病的双相I型患者的酒精依赖严重程度有所改善，但这些患者的不良结局可能是由于与人格障碍和其他物质使用障碍的共病率较高，这些障碍与酒精依赖一起最终导致更差的症状和功能临床结局。
