DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20202259

Study of clinical profile of patients of bipolar mood disorder with and without substance abuse and clinical course variables in the substance abusing bipolar group in one of the tertiary care centre of North India

Vineet Sharma, Sunny Garg, Dinesh D. Sharma, Alka Chauhan, Milli Sharma

Abstract


Background: Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 3% in general population. In patients with bipolar disorder there was 58 % lifetime prevalence of co-occurring alcohol abuse and a 38 % lifetime prevalence of co-occurring other substance abuse. Substance abuse interferes with treatment and management approaches of the bipolar disorder.

Methods: A cross sectional observational study of 120 male patients divided in substance abusing (60) and non-substance abusing groups (60) with bipolar disorder according to DSM-V, who met the Inclusion criteria . A written informed consent was obtained from the patients and/ or their family members. Patient’s information was recorded on the socio-demographic and clinical profile sheet .Thereafter, YMRS or HAM-D scales were applied as per the phase of the illness.

Results: Most of the patients were between 15-25 years in SAB group and 35-50 years in NSAB group, educated, semiskilled and married. Tobacco abuse was the commonest followed by cannabis and alcohol abuse. The mean duration of hospital stay in SAB group was 41.40 days and in NSAB group was 43.20 days. Dysphoric mania, aggressive behavior and suicidal attempts were more in SAB group. Mean total YMRS score of SAB group was greater than NSAB group.

Conclusions: Maximum patients had onset of substance abuse before the onset of affective symptoms. Manic symptomatology was more severe in substance abusing group.


Keywords


Affective symptoms, Bipolar disorder, Substance abuse

Full Text:

PDF

References


Schmitt A, Malchow B, Hasan A, Fallkai P. The impact of environmental factors in severe psychiatric disorders. Frontiers Neurosci. 2014 Feb 11;8:19.

Bipolar and Related disorders. In: Textbook of Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association, 2013; 348.

Substance Related disorders. In: Textbook of Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association, 2013; 621-622.

Strakowski SM, DelBello MP. The co-occurrence of bipolar and substance use disorders. Clini Psychol Rev. 2000 Mar 1;20(2):191-206.

Davidson KM, Ritson EB. The relationship between alcohol dependence and depression. Alcohol Alcoholism. 1993 Mar 1;28(2):147-55.

Schuckit MA. Genetic and clinical implications of alcoholism and affective disorder. Am J Psych. 1986 Feb.

Sonne SC, Brady KT. Substance abuse and bipolar comorbidity. Psych Clin North Am. 1999 Sep 1;22(3):609-27.

DelBello MP, Strakowski SM, Sax KW, McElroy SL, Keck Jr PE, West SA, Kmetz GF. Familial rates of affective and substance use disorders in patients with first-episode mania. J Affect Disor. 1999 Nov 1;56(1):55-60.

Escamilla MA, Batki S, Reus VI, Spesny M, Molina J, Service S, Vinogradov S, Neylan T, Mathews C, Meza L, Gallegos A. Comorbidity of bipolar disorder and substance abuse in Costa Rica: pedigree-and population-based studies. . J Affect Disor. 2002 Sep 1;71(1-3):71-83.

Winokur G, Coryell W, Akiskal HS, Maser JD, Keller MB, Endicott J, Mueller T. Alcoholism in manic-depressive (bipolar) illness: familial illness, course of illness, and the primary-secondary distinction. Am J Psych. 1995 Mar.

Strakowski SM, McElroy SL, Keck Jr PE, West SA. The effects of antecedent substance abuse on the development of first-episode psychotic mania. J Psych Res. 1996 Jan 1;30(1):59-68.

Kumar BR, Dudala SR, Rao AR. Kuppuswamy’s socio-economic status scale–a revision of economic parameter for 2012. Int J Res Dev Health. 2013 Jan;1(1):2-4.

Bernadt MW, Murray RM. Psychiatric Disorder, Drinking and Alcoholism:: What are the Links?. The Br J Psych. 1986 Apr;148(4):393-400.

Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psych. 1978 Nov;133(5):429-35.

Hamilton M. A rating scale for depression. J Neurol, Neurosur, Psych. 1960 Feb;23(1):56-61.

Ray R, Chandrasekhar K. Detection of alcoholism among psychiatric inpatients. Ind J Psych. 1982 Oct;24(4):389-99.

Khalid A, Kunwar AR, Rajbhandari KC, Sharma VD, Regmi SK. A study of prevalence and comorbidity of depression in alcohol dependence. Ind J Psych. 2000 Oct;42(4):434-8.

Tien AY, Anthony JC. Epidemiological analysis of alcohol and drug use as risk factors for psychotic experiences. J Nervous Mental Dis. 1990 Aug.

Verdoux H, Mury M, Besancon G, Bourgeois M. Comparative study of substance dependence comorbidity in bipolar, schizophrenic and schizoaffective disorders. L'Encephale. 1996;22(2):95-101.

Morrison JR. Bipolar affective disorder and alcoholism. Am J Psych. 1974 Oct;131(10):1130-3.

Sonne SC, Brady KT, Morton WA. Substance abuse and bipolar affective disorder. J Nervous Mental Dis. 1994 Jun.

Tsai SY, Chen CC, Yeh EK. Alcohol problems and long-term psychosocial outcome in Chinese patients with bipolar disorder. J Affect Disor. 1997 Nov 1;46(2):143-50.

DelBello MP, Strakowski SM, Sax KW, McElroy SL, Keck PE Jr, West SA, et al. Effects of familial rates of affective illness and substance abuse on rates of substance abuse in patients with first episode mania. J Affect Disord. 2009;56: 55-60.

Mueser KT, Yarnold PR, Bellack AS. Diagnostic and demographic correlates of substance abuse in schizophrenia and major affective disorder. Acta Psych Scandin. 1992 Jan;85(1):48-55.

Feinman JA, Dunner DL. The effect of alcohol and substance abuse on the course of bipolar affective disorder. J Affect Disor. 1996 Feb 12;37(1):43-9.

Pini S, Dell'Osso L, Mastrocinque C, Marcacci G, Papasogli A, Vignoli S, Pallanti S, Cassano GB. Axis I comorbidity in bipolar disorder with psychotic features. Br J Psych. 1999 Nov;175(5):467-71.

Strakowski SM, Sax KW, McElroy SL, Keck Jr PE, Hawkins JM, West SA. Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization. J Clini Psych. 1998 Sep 1;59(9):465-71.

Himmelhoch JM, Mulla D, Neil JF, Detre TP, Kupfer DJ. Incidence and significance of mixed affective states in a bipolar population. Arch Gen Psych. 1976 Sep 1;33(9):1062-6.

Brown ES, Suppes T, Adinoff B, Thomas NR. Drug abuse and bipolar disorder: comorbidity or misdiagnosis?. J Affect Disor. 2001 Jul 1;65(2):105-15.

Warner R, Taylor D, Wright J, Sloat A, Springett G, Arnold S, Weinberg H. Substance use among the mentally ill: prevalence, reasons for use, and effects on illness. Am J Orthopsych. 1994 Jan;64(1):30-9.

O'Connell RA, Mayo JA, Flatow L, Cuthbertson B, O'Brien BE. Outcome of bipolar disorder on long-term treatment with lithium. Br J Psych. 1991 Jul;159(1):123-9.

Halsband SA. Bipolar Disorder and substance abuse: an explosive mixture?. Vertex. 2003;14:7-10.

Dalton EJ, Cate‐Carter TD, Mundo E, Parikh SV, Kennedy JL. Suicide risk in bipolar patients: the role of co‐morbid substance use disorders. Bipol Disor. 2003 Feb;5(1):58-61.

Potash JB, Kane HS, Chiu YF, Simpson SG, MacKinnon DF, McInnis MG, McMahon FJ, DePaulo Jr JR. Attempted suicide and alcoholism in bipolar disorder: clinical and familial relationships. Am J Psych. 2000 Dec 1;157(12):2048-50.

Brady KT, Sonne SC. The relationship between substance abuse and bipolar disorder. J Clini Psych. 1995.

Sachdeva JS, Singh S, Sidhu BS, Goyal RK, Singh J. An epidemiological study of psychiatric disorders in rural Faridkot (Punjab). Ind J Psych. 1986 Oct;28(4):317.

Mayfield DG, Coleman LL. Alcohol use and affective disorder. Dis Nervous Sys. 1968.