Preuss Ulrich W, Hesselbrock Michie N, Hesselbrock Victor M
Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, RKH Hospital Ludwigsburg, 71640 Ludwigsburg, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics, Martin Luther-University Halle-Wittenberg, 06112 Halle, Germany.
Brain Sci. 2023 Jul 27;13(8):1130. doi: 10.3390/brainsci13081130.
The comorbidity of alcohol and substance use disorders among persons with bipolar disorder is elevated, as indicated by epidemiological and clinical studies. Following alcohol use, cannabis is the most frequently used and abused illicit substance among bipolar individuals, and such use may lead to comorbid cannabis use disorders (CUD). Previous research indicated that CUDs were related to a more severe course of bipolar disorder and higher rates of other comorbid alcohol and substance use disorders. Few studies, however, have conducted longitudinal research on this comorbidity. The aim of this study is to investigate the influence of CUD on the course of bipolar I and II individuals during a 5-year follow-up.
The characteristics of bipolar disorder, cannabis use disorders, and other alcohol and substance use disorders, as well as comorbid mental disorders, were assessed using a standardized semi-structured interview (SSAGA) at both baseline and the 5-year follow-up. N = 180 bipolar I and II patients were subdivided into groups of with and without comorbid cannabis use disorders (CUD).
Of the 77 bipolar I and 103 bipolar II patients, n = 65 (36.1%) had a comorbid diagnosis of any CUD (DSM-IV cannabis abuse or dependence). Comorbid bipolar patients with CUD had higher rates of other substance use disorders and posttraumatic stress disorders, more affective symptoms, and less psychosocial functioning at baseline and at 5-year follow-up. In contrast to previously reported findings, higher rates of anxiety disorders and bipolar disorder complications (e.g., mixed episodes, rapid cycling, and manic or hypomanic episodes) were not found. The effect of CUD on other substance use disorders was confirmed using moderation analyses.
A 5-year prospective evaluation of bipolar patients with and without CUD confirmed previous investigations, suggesting that the risk of other substance use disorders is significantly increased in comorbid individuals. CUD has a moderation effect, while no effect was found for other mental disorders. Findings from this study and previous research may be due to the examination of different phenotypes (Cannabis use vs. CUD) and sample variation (family study vs. clinical and epidemiological populations).
流行病学和临床研究表明，双相情感障碍患者中酒精与物质使用障碍的共病情况有所增加。在饮酒之后，大麻是双相情感障碍患者中最常使用和滥用的非法物质，这种使用可能导致共病大麻使用障碍（CUD）。先前的研究表明，CUD与双相情感障碍更严重的病程以及其他酒精和物质使用障碍的更高发生率有关。然而，很少有研究对这种共病情况进行纵向研究。本研究的目的是在5年随访期间调查CUD对I型和II型双相情感障碍患者病程的影响。
在基线和5年随访时，使用标准化半结构化访谈（SSAGA）评估双相情感障碍、大麻使用障碍以及其他酒精和物质使用障碍的特征，以及共病精神障碍。180例I型和II型双相情感障碍患者被分为有和没有共病大麻使用障碍（CUD）的两组。
在77例I型双相情感障碍患者和103例II型双相情感障碍患者中，n = 65（36.1%）有任何CUD（DSM-IV大麻滥用或依赖）的共病诊断。共病CUD的双相情感障碍患者在基线和5年随访时，其他物质使用障碍和创伤后应激障碍的发生率更高，情感症状更多，社会心理功能更少。与先前报道的结果相反，未发现焦虑障碍和双相情感障碍并发症（如混合发作、快速循环以及躁狂或轻躁狂发作）的发生率更高。使用调节分析证实了CUD对其他物质使用障碍的影响。
对有和没有CUD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，表明共病个体中其他物质使用障碍的风险显著增加。CUD有调节作用，而对其他精神障碍未发现有影响。本研究和先前研究的结果可能归因于对不同表型（大麻使用与CUD）的检查以及样本差异（家族研究与临床和流行病学人群）。
