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. 2010 Sep-Oct;19(5):440-9.
doi: 10.1111/j.1521-0391.2010.00060.x.

Independent predictors for lifetime and recent substance use disorders in patients with rapid-cycling bipolar disorder: focus on anxiety disorders

Keming Gao  1 , Philip K Chan, Marcia L Verduin, David E Kemp, Bryan K Tolliver, Stephen J Ganocy, Sarah Bilali, Kathleen T Brady, Robert L Findling, Joseph R Calabrese
Affiliations

Independent predictors for lifetime and recent substance use disorders in patients with rapid-cycling bipolar disorder: focus on anxiety disorders

Keming Gao et al. Am J Addict. 2010 Sep-Oct.

Abstract

We set out to study independent predictor(s) for lifetime and recent substance use disorders (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 (odds ratio [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, 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 GAD, later treatment with a mood stabilizer, and early childhood trauma and history of SUDs suggest 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.

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Conflict of interest statement

Declaration of Interest

Dr. Gao receives or has received, acted as a consultant and/or served on a speaker’s bureau for Abbott, AstraZeneca, Pfizer, Schering-Plough, 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 for Bipolar Disorders Research Fellowship Award; KL2 RR024990

Dr. Tolliver receives grant support from Forest Laboratories.

Dr. Ganocy Received grant support from Eli Lilly Co.

Dr. Findling receives or has received research support, acted as a consultant and/or served on a speaker’s bureau for Abbott, Addrenex, AstraZeneca, Biovail, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Johnson & Johnson, KemPharm Lilly, Lundbeck, Neuropharm, Novartis, Noven, Organon, Otsuka, Pfizer, Sanofi-Aventis, Sepracore, Shire, Solvay, Supernus Pharmaceuticals, Validus, and Wyeth.

Dr. Calabrese has received federal funding from the Department of Defense, Health Resources Services Administration and National Institute of Mental Health. He has received research support from Abbott, AstraZeneca, Bristol-Myers Squibb, Cephalon, Cleveland Foundation, Eli Lilly, GlaxoSmithKline, Janssen, NARSAD, Repligen, Stanley Medical Research Institute, Takeda and Wyeth. He consulted to or served on advisory boards of Abbott, AstraZeneca, Bristol-Myers Squibb, Cephalon, Dainippon Sumitomo, EPI-Q, Inc., Forest, France Foundation, GlaxoSmithKline, Janssen, Johnson and Johnson, Lundbeck, Neurosearch, OrthoMcNeil, Otsuka, Pfizer, Repligen, Schering-Plough, Servier, Solvay, Supernus, Synosia, and Wyeth. He has provided CME lectures supported by Abbott, AstraZeneca, Bristol-Myers Squibb, France Foundation, GlaxoSmithKline, Janssen, Johnson and Johnson, Sanofi Aventis, Schering-Plough, Pfizer, Solvay, and Wyeth.

The other authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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