Grunze Heinz, Schaefer Martin, Scherk Harald, Born Christoph, Preuss Ulrich W
Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany.
Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Front Psychiatry. 2021 Mar 23;12:660432. doi: 10.3389/fpsyt.2021.660432. eCollection 2021.
Comorbidity rates in Bipolar disorder rank highest among major mental disorders, especially comorbid substance use. Besides cannabis, alcohol is the most frequent substance of abuse as it is societally accepted and can be purchased and consumed legally. Estimates for lifetime comorbidity of bipolar disorder and alcohol use disorder are substantial and in the range of 40-70%, both for Bipolar I and II disorder, and with male preponderance. Alcohol use disorder and bipolarity significantly influence each other's severity and prognosis with a more complicated course of both disorders. Modern treatment concepts acknowledge the interplay between these disorders using an integrated therapy approach where both disorders are tackled in the same setting by a multi-professional team. Motivational interviewing, cognitive behavioral and socio- therapies incorporating the family and social environment are cornerstones in psychotherapy whereas the accompanying pharmacological treatment aims to reduce craving and to optimize mood stability. Adding valproate to lithium may reduce alcohol consumption whereas studies with antipsychotics or naltrexone and acamprosate did not affect mood fluctuations or drinking patterns. In summary, there is a continuous need for more research in order to develop evidence-based approaches for integrated treatment of this frequent comorbidity.
双相情感障碍的共病率在主要精神障碍中位居榜首，尤其是合并物质使用障碍。除大麻外，酒精是最常被滥用的物质，因为它在社会上被接受，且可以合法购买和消费。双相情感障碍与酒精使用障碍的终生共病率估计相当高，双相I型和II型障碍的共病率均在40%-70%之间，且男性更为常见。酒精使用障碍和双相情感障碍会显著影响彼此的严重程度和预后，导致两种疾病的病程更加复杂。现代治疗理念认可这些疾病之间的相互作用，采用综合治疗方法，由多专业团队在同一环境中同时处理这两种疾病。动机性访谈、认知行为疗法以及纳入家庭和社会环境的社会疗法是心理治疗的基石，而伴随的药物治疗旨在减少渴望并优化情绪稳定性。在锂盐基础上加用丙戊酸盐可能会减少酒精摄入量，而使用抗精神病药物、纳曲酮或阿坎酸的研究并未影响情绪波动或饮酒模式。总之，持续需要开展更多研究，以便为这种常见的共病开发基于证据的综合治疗方法。
