The effects of antecedent substance abuse on the development of first-episode psychotic mania.

We examined associations of antecedent drug and alcohol abuse with age of onset of bipolar disorder and the time to hospitalization in a sample of 59 patients presenting with their first episode of psychotic mania. Patients with first-episode manic or mixed bipolar disorder with psychotic features were recruited from consecutive hospitalizations and evaluated using structured diagnostic instruments. Antecedent alcohol abuse was present in 12 patients (20%), and antecedent drug abuse in 19 (32%). Antecedent alcohol abuse was associated with a later age of onset of the bipolar disorder, although antecedent drug abuse was not associated with age of onset. Patients with antecedent drug or alcohol abuse required hospitalization sooner than those without. These preliminary findings suggest that patients with bipolar disorder and antecedent alcohol abuse may have a later onset of their affective illness, perhaps representing a subgroup of patients in whom previous alcohol abuse is necessary to precipitate an affective episode. Regardless, the presence of antecedent substance abuse leads to more rapid hospitalization in these patients. Our results should be considered preliminary, given the small sample size and the post-hoc design of the study. Additional prospective studies of patients with new onset bipolar disorder and antecedent substance abuse syndromes are needed to further clarify the complex relationships between substance abuse and bipolar disorder.