Substance Misuse Trajectories and Risk of Relapse in the Early Course of Bipolar Disorder

Abstract

Substance misuse is highly prevalent in bipolar disorder even in the early illness phases. However, the trajectories of misuse of different substances after treatment initiation is not well-studied. Also, knowledge on how substance misuse trajectories influence the early course of bipolar disorder is limited. We recruited 220 individuals in first treatment of bipolar disorder of which 112 participated in a 1-year follow-up study at the NORMENT center in Oslo, Norway. Misuse was defined as having scores above cut-off for harmful use on the Alcohol or Drug Use Disorders Identification Tests (AUDIT or DUDIT). We investigated rates of stopping and continuing misuse of alcohol, cannabis and other illicit substances and daily nicotine use over the follow-up period, and whether such misuse trajectories predicted the risk for affective relapse. The prevalence of cannabis misuse was reduced from 29 to 15% and alcohol misuse was reduced from 39 to 21% during follow-up. Continuing alcohol misuse significantly and independently predicted affective relapse, whereas there was no difference in relapse risk between individuals stopping alcohol misuse and never misusing alcohol. Cannabis misuse trajectories did not significantly predict relapse risk although we cannot exclude interactions with alcohol misuse. In conclusion, substance misuse decreased in the early phase of bipolar disorder treatment but should be further reduced with interventions specifically addressing substance misuse. Stopping alcohol misuse is likely to yield substantial benefit on the clinical course of bipolar disorder.

Psychotic features, particularly mood incongruence, as a hallmark of severity of bipolar I disorder

“…First, given the highly increased risk of professional inactivity in patients with psychotic features, therapeutic and rehabilitative efforts that aim at reducing the impact of psychotic symptoms on the patient’s professional activity are advocated. Second, efforts to detect and treat the frequent comorbid alcohol abuse in patients with psychotic features are also advocated as a means of maximizing the clinical course of BD, as outlined by a recent study (Lagerberg et al 2021 ). Third, in patients with MI psychotic features, the largely increased risk of suicidal attempts needs particular clinical attention.…”

Composite immune marker scores associated with severe mental disorders and illness course

“…Up to one third of patients with schizophrenia experience a chronic course with limited effect of therapy and a similar proportion has a benign course ( Marder and Cannon, 2019 ). Likewise, the course of bipolar disorder varies significantly between afflicted individuals ( Lagerberg et al, 2021 ; Turvey et al, 1999 ). The heterogeneity probably reflects different underlying disease mechanisms.…”

Study of reasons for relapse in patients with bipolar I disorder with repeat admissions and its correlation with substance use

“…9 Thus, a better understanding of the factors that lead to repeated admissions, increased relapse rates, and concurrent substance dependence is necessary for the development of interventions that may reduce the likelihood of adverse effects in patient with bipolar I disorder. 10 With this background in mind, the present study will focus on factors causing relapse, repeated admissions, and its correlation with substance use in patients of bipolar I disorder admitted in psychiatry ward.…”