Independent Predictors for Lifetime and Recent Substance Use Disorders in Patients with Rapid‐Cycling Bipolar Disorder: Focus on Anxiety Disorders

Abstract

We set out to study independent predictor(s) for lifetime and recent substance use disorder (SUDs) in patients with rapid cycling bipolar disorder (RCBD). Extensive Clinical Interview and Mini International Neuropsychiatric Interview were used to ascertain DSM-IV Axis I diagnoses of RCBD, anxiety disorders, and SUDs. Data from patients enrolling into four similar clinical trials were used. Where appropriate, univariate analyses with t-test or Chi-Square were applied. Stepwise logistic regression was used to examine the relationship among predictor variables and lifetime and recent SUDs. Univariate analysis showed that patients with co-occurring anxiety disorders (n=261) had significantly increased rates of lifetime (OR=2.1) and recent (OR=1.9) alcohol dependence as well as lifetime (OR=3.4) and recent (OR=2.5) marijuana dependence compared to those without co-occurring anxiety disorder (n=303). In logistic regression analyses, Address correspondence to Dr. Gao, 10524 Euclid Avenue, 12 th floor, Cleveland, OH 44106. keming.gao@uhhospitals.org. Dr. Verduin is currently at the Department of Medical Education, University of Central Florida, College of Medicine in Orlando, Florida. Declaration of InterestDr. Gao receives or has received, acted as a consultant and/or served on a speaker's bureau for Abbott, AstraZeneca, Pfizer, ScheringPlough, and NARSAD. Dr. Verduin has received grant support from Bristol-Myers Squibb, Eli Lilly, and Janssen. Dr. Kemp serves on the speaker's bureau for Astra-Zeneca and Pfizer, and serves as a consultant for Bristol-Myers Squibb. He has received research support from Takeda (study medication only, no financial support), NARSAD, and the International Society NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript generalized anxiety disorder (GAD) was associated with increased risk for lifetime SUDs (OR=2.34), alcohol dependence (OR=1.73), and marijuana dependence (OR=3.36), and recent marijuana dependence (OR=3.28). A history of physical abuse was associated with increased risk for lifetime SUDs (OR=1.71) and recent marijuana dependence (OR=3.47). Earlier onset of first mania/hypomania was associated with increased risk for lifetime SUDs (5% per year) and recent marijuana dependence (12% per year) and later treatment with a mood stabilizer were also associated with increased risk for recent SUDs (8% per year). Positive associations between generalized anxiety disorder, later treatment with a mood stabilizer, and early childhood trauma and history of SUDs suggests that adequate treatment of comorbid anxiety, early treatment with a mood stabilizer, and prevention of childhood trauma may reduce the risk for the development of SUDs in patients with bipolar disorder.

Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses

“…In this analysis, diagnoses of substance abuse and alcoholism were more frequent in the seriously mentally ill patients (OAS) than in the primary care control group (PRISM) as has been reported in other studies (28–30). However the frequencies of most comorbid medical conditions including such chronic conditions as diabetes and hypertension for the seriously mentally ill patients (OAS), although high, were similar to those in our comparative group of medical outpatient attendees (PRISM).…”

Psychosocial Determinants of Cannabis Dependence: A Systematic Review of the Literature

“…However, one paper did not find significant interaction between cannabis dependence and major depression [41] . In other studies, higher rates of anxiety disorders, dysthymia and bipolar disorders have been noted among dependent individuals [33,38,43] . The role of panic disorder in development of dependence has been mixed.…”

“…Indeed, lifetime and past-year history of panic disorder may also exert its influence on the onset of cannabis dependence [33,38] . However, in the study by Gao et al [43] , history of panic disorder was not a predictor of cannabis dependence. In one study, generalized anxiety independently predicted recent and lifetime cannabis dependence among patients with rapid cycling.…”

“…Consistent with the finding of von Sydow et al [41] , Chen et al [42] showed that the use of 3 or more drugs prior to starting cannabis marked a threshold of risk for later dependence. In addition, some evidence suggests that a lifetime prevalence of cannabis dependence correlated positively with cocaine abuse [43] . However, cannabis dependence seems not always to be necessarily determined by the use of other illicit substances [39] .…”

“…Hence, among frequent cannabis users, periods of abstinence rather than reduced use may be beneficial to future use patterns. Moreover, younger age at first cannabis use appeared to be of crucial importance to development of dependence [41][42][43]47] . The highest probability of becoming dependent was found in users with first use at the age of 14-15 years.…”