Department of Psychology, University of Michigan, Ann Arbor.
Department of Psychiatry, University of Michigan, Ann Arbor.
JAMA Netw Open. 2024 Jun 3;7(6):e2415295. doi: 10.1001/jamanetworkopen.2024.15295.
Alcohol use disorder (AUD) is present in nearly half of individuals with bipolar disorder (BD) and is associated with markedly worsening outcomes. Yet, the concurrent treatment of BD and AUD remains neglected in both research and clinical care; characterizing their dynamic interplay is crucial in improving outcomes.
To characterize the longitudinal alcohol use patterns in BD and examine the temporal associations among alcohol use, mood, anxiety, and functioning over time.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study selected participants and analyzed data from the Prechter Longitudinal Study of Bipolar Disorder (PLS-BD), an ongoing cohort study that recruits through psychiatric clinics, mental health centers, and community outreach events across Michigan and collects repeated phenotypic data. Participants selected for the present study were those with a diagnosis of BD type I (BDI) or type II (BDII) who had been in the study for at least 5 years. Data used were extracted from February 2006 to April 2022, and follow-up ranged from 5 to 16 years.
Alcohol use was measured using the Alcohol Use Disorders Identification Test. Depression, mania or hypomania, anxiety, and functioning were measured using the 9-Item Patient Health Questionnaire, the Altman Self-Rating Mania Scale, the 7-item Generalized Anxiety Disorder assessment scale, and the Life Functioning Questionnaire, respectively.
A total of 584 individuals (386 females (66.1%); mean [SD] age, 40 [13.6] years) were included. These participants had a BDI (445 [76.2%]) or BDII (139 [23.8%]) diagnosis, with or without a lifetime diagnosis of AUD, and a median (IQR) follow-up of 9 (0-16) years. More problematic alcohol use was associated with worse depressive (β = 0.04; 95% credibility interval [CrI], 0.01-0.07) and manic or hypomanic symptoms (β = 0.04; 95% CrI, 0.01-0.07) as well as lower workplace functioning (β = 0.03; 95% CrI, 0.00-0.06) over the next 6 months, but increased depressive and manic or hypomanic symptoms were not associated with greater subsequent alcohol use. These latter 2 associations were more pronounced in BDII than BDI (mania or hypomania: β = 0.16 [95% CrI, 0.02-0.30]; workplace functioning: β = 0.26 [95% CrI, 0.06-0.45]). Alcohol use was not associated with anxiety over time.
This study found that alcohol use, regardless of diagnostic status, was associated with mood instability and poorer work functioning in BD, but increased mood symptoms were not associated with subsequent alcohol use. Given its prevalence and repercussions, dimensional and longitudinal assessment and management of alcohol use are necessary and should be integrated into research and standard treatment of BD.
在双相情感障碍（BD）患者中，近一半的人存在酒精使用障碍（AUD），并且与明显恶化的结局有关。然而，BD 和 AUD 的同时治疗在研究和临床护理中仍然被忽视；描述它们的动态相互作用对于改善结果至关重要。
描述 BD 中的纵向饮酒模式，并检查随着时间的推移，饮酒、情绪、焦虑和功能之间的时间关联。
设计、地点和参与者：这项队列研究从密歇根州的精神病诊所、心理健康中心和社区外展活动中招募参与者，并分析了正在进行的双相情感障碍纵向研究（PLS-BD）的数据，这是一个正在进行的队列研究。参与者入选本研究的标准是患有 I 型双相情感障碍（BDI）或 II 型双相情感障碍（BDII），且在该研究中至少有 5 年的随访时间。本研究使用的数据是从 2006 年 2 月到 2022 年 4 月提取的，随访时间为 5 至 16 年。
使用酒精使用障碍识别测试来衡量饮酒情况。使用 9 项患者健康问卷、Altman 自我评定躁狂量表、7 项广泛性焦虑症评估量表和生活功能问卷分别衡量抑郁、躁狂或轻躁狂、焦虑和功能。
共纳入 584 名参与者（386 名女性（66.1%）；平均[标准差]年龄 40[13.6]岁）。这些参与者有 BDI（445[76.2%]）或 BDII（139[23.8%]）诊断，有或没有终生 AUD 诊断，中位（IQR）随访时间为 9（0-16）年。更严重的饮酒问题与更严重的抑郁（β=0.04；95%可信区间[CrI]，0.01-0.07）和躁狂或轻躁狂症状（β=0.04；95%CrI，0.01-0.07）以及较低的工作场所功能（β=0.03；95%CrI，0.00-0.06）有关，但随后的抑郁和躁狂或轻躁狂症状并没有导致更多的饮酒。这些后两种关联在 BDII 中比 BDI 更为明显（躁狂或轻躁狂：β=0.16[95%CrI，0.02-0.30]；工作场所功能：β=0.26[95%CrI，0.06-0.45]）。饮酒与焦虑之间无时间关联。
本研究发现，无论诊断状态如何，饮酒与 BD 中的情绪不稳定和较差的工作功能有关，但情绪症状的增加与随后的饮酒无关。鉴于 AUD 的高患病率和影响，BD 的多维和纵向评估和管理是必要的，应纳入研究和标准治疗。
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