Department of Psychiatry, University of Perugia, Perugia, Italy.
Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.
J Affect Disord. 2022 Mar 1;300:326-333. doi: 10.1016/j.jad.2022.01.001. Epub 2022 Jan 3.
Substance use disorders (SUD) in bipolar disorders (BD) present relevant impact on psychopathological features and illness course. The present study was aimed at analyzing the clinical correlates of this comorbidity.
In- and outpatients suffering from BD were recruited. Socio-demographic and clinical characteristics were collected. Subjects underwent a psychopathological assessment evaluating affective temperaments and impulsiveness. The appraisal of treatment response to mood stabilizers was conducted with the Alda Scale. Bivariate analyses were used to compare subjects suffering from BD with (SUD-BD) or without comorbid SUD (nSUD-BD) (p<0.05). A logistic regression model was performed to identify specific correlates of SUD in BD.
Among the 161 included subjects, 63 (39.1%) were diagnosed with comorbid SUD. SUD-BD subjects showed younger age at onset (p = 0.003) and higher prevalence of BD type I diagnosis (BDI) (p<0.001). Furthermore, lifetime mixed features (p<0.001), psychotic symptoms (p<0.001), suicide attempts (p = 0.002), aggression (p = 0.003), antidepressant-induced manic switch (p = 0.003), and poor treatment response (p<0.001) were more frequent in the SUD-BD subgroup. At the logistic regression, SUD revealed a positive association with BD type I diagnosis (Odds Ratio (OR) 4.77, 95% CI 1.66-13.71, p = 0.004) and mixed features (OR 2.54, 95% CI 1.17-5.53, p = 0.019).
The cross-sectional study design and the relatively small sample size may limit the generalizability of the findings. The retrospective evaluation of comorbid SUD could have biased the outcome assessment.
Subjects with BD and SUD are characterized by higher clinical severity and require careful assessment of treatment response.
双相障碍（BD）中的物质使用障碍（SUD）对精神病理学特征和疾病过程有显著影响。本研究旨在分析这种共病的临床相关性。
招募了患有 BD 的住院和门诊患者。收集了社会人口统计学和临床特征。对受试者进行了精神病理学评估，评估了情感气质和冲动性。使用 Alda 量表评估对心境稳定剂的治疗反应。使用双变量分析比较了患有 BD 合并 SUD（SUD-BD）或无共病 SUD（nSUD-BD）的患者（p<0.05）。进行逻辑回归模型以确定 BD 中 SUD 的特定相关性。
在纳入的 161 名受试者中，有 63 名（39.1%）被诊断为共病 SUD。SUD-BD 患者的发病年龄较轻（p=0.003），BDI 诊断为 I 型的比例较高（p<0.001）。此外，终生混合特征（p<0.001）、精神病症状（p<0.001）、自杀企图（p=0.002）、攻击行为（p=0.003）、抗抑郁药引起的躁狂发作（p=0.003）和治疗反应不佳（p<0.001）在 SUD-BD 亚组中更为常见。在逻辑回归中，SUD 与 BDI 诊断为 I 型（优势比（OR）4.77，95%置信区间（CI）1.66-13.71，p=0.004）和混合特征（OR 2.54，95%CI 1.17-5.53，p=0.019）呈正相关。
横断面研究设计和相对较小的样本量可能限制了研究结果的普遍性。共病 SUD 的回顾性评估可能会影响结果评估。
患有 BD 和 SUD 的患者的临床严重程度较高，需要仔细评估治疗反应。
