Bipolar disorder and co-occurring cannabis use disorders

AimsAssess the prevalence of cannabis use disorders (CUD) in patients with bipolar disorder, describe the demographic and clinical profile socio bipolar patients with comorbid addictive and assess the implications of this comorbidity on prognosis and evolution of bipolar disorder.MethodsA case-control study, 100 euthymic patients treated for bipolar disorder, recruited in the department of psychiatry C of Razi hospital. Two groups were individualized by the presence or not of cannabis use disorders comorbidity. The two groups were compared for sociodemographic, clinical, therapeutic and historical characteristics.ResultsThe prevalence of CUD was 27.53% (n = 19) in our sample. Comparing bipolar patients according to the presence or absence of CUD, we found the following results with patients with CUD comorbidity: younger, mostly male, a disturbed family dynamic, low educational level, poor socio-economic conditions, more time abroad history, more suicide attempts in history, more criminal record, more psychiatric family history, an earlier onset of the disease, a longer duration of undiagnosed bipolar disorder, more personality disorder, more frequent presence of a triggering factor for bipolar disorder, more psychotic features during mood episodes, more need of antipsychotic long-term treatment.ConclusionsThe frequency of CUD in BD is higher than the prevalence in the general population and CUD is a factor in the evolution and prognosis of bipolar disorder and promotes the development of mood disorders in predisposed patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Aspects of the psychological consequences of cannabis use

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.563 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S479-S479

Author(s):

L. Montes Reula ◽

A. Portilla Fernández ◽

H. Saiz García

Keyword(s):

Bipolar Disorder ◽

Suicide Attempts ◽

Age At Onset ◽

Cannabis Use ◽

Psychological Consequences ◽

Course Of Illness ◽

Adult Age ◽

Affective Symptoms ◽

Competing Interest ◽

The Relationship

Cannabis is seen among general population as an “anti-depressive drug”. Many papers have been published in the field of investigation about the relationship between cannabis use and affective disorders. We pretend to find the aspect of the psychological consequences of cannabis use.MethodsUsing Pubmed and PsychInfo, we conducted a narrative review of the literature on cannabis and psychiatric comorbidity using the keywords cannabis, psychosis, mood, depression, mania, bipolar, and anxiety.ResultsThere is substantial evidence of an association between cannabis use and psychosis. A few reports suggest an association with bipolar disorder while the association with depression and anxiety disorders is mixed.ConclusionsThe present review confirms earlier findings of an association between cannabis use and a lower age at onset. Data shows that cannabis use, beginning in the adolescence and with a frequency higher than once a week, correlates with the development in adult age of affective symptoms and/or disorder, mainly in bipolar disorder, with a moderate relation with Depressive spectrum. Even more, some authors hypothesize that cannabis may play a role in the development of the disorder, that to say, affective disorder would not appear in the absence of cannabis use. The current findings suggest that recent cannabis use is associated with a more severe course of illness in the early phase of BD I.Recent cannabis use was also associated with more lifetime suicide attempts.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

The Role of Long Acting Antipsychotics in Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.099 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S15-S15

Author(s):

E. Vieta

Keyword(s):

Bipolar Disorder ◽

Meta Analysis ◽

Term Treatment ◽

Patient Profile ◽

Long Term Treatment ◽

Short And Long Term ◽

Competing Interest ◽

Long Acting

Antipsychotics are widely used for the short and long-term treatment of bipolar disorder. Depot and long-acting injectable formulations (LAIs) can be particularly useful for certain subgroups of patients. This lecture will discuss the available data from randomized controlled trials of LAIs in bipolar disorder. A recently published meta-analysis and individual studies assessing depot medications, as well as modern LAIs such as risperidone, paliperidone and aripiprazole, will be reviewed, looking carefully into the prevention of either pole of illness and tolerability. Potential indications and patient profile, based on data and clinical experience, will be discussed.Disclosure of interestThe author has not supplied his declaration of competing interest.

Download Full-text

Bipolar Disorder and Cannabis

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1908 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S118-S119

Author(s):

G. Jmii ◽

M. Zghal ◽

F. Ghali ◽

M. Mezghenni ◽

L. Jouini ◽

...

Keyword(s):

Bipolar Disorder ◽

Substance Dependence ◽

Suicide Attempts ◽

Bipolar Disorders ◽

Cross Sectional Study ◽

Cannabis Use ◽

Type I ◽

Cross Sectional ◽

Average Hospital ◽

Bipolar Patients

IntroductionPeople with bipolar disorder frequently struggle with substance abuse and dependence. Typically, cannabis is the most commonly abused drug in individuals with bipolar disorder. Some investigators have implied that cannabis may actually be mood stabilizing in patients with bipolar disorder. However, the relationships between cannabis use and bipolar disorders are complex and remain incompletely described.ObjectiveThe aim of this study was to identify the characteristics of addiction to cannabis in bipolar patients type I and determine the consequences of cannabis on the expression of bipolar illness and prognosis.MethodsThis is a comparative cross-sectional study which included patients followed in the psychiatry department of the G Razi hospital for bipolar disorder type I and for substance dependence according to DSM IV diagnostic criteria. Hetero-questionnaire on sociodemographic variables, clinical and treatment.ResultsThe average age was 41 years. The average hospital stay was 9.18 days. 33.33% of patients were monitored regularly. Most patients were single and worked as a day labourer. Cannabis was the most consumed substance. Cannabis use was prior to the expression of psychiatric illness in 55% of cases. The average number of hospitalisation in patients with a cannabis addiction was significantly greater than that observed in the non-addicted group. Similarly, the average number of suicide attempts among patients with cannabis addiction was significantly higher than the group without cannabis addiction.ConclusionsAggressive drug abuse treatment immediately after a first psychiatric hospitalisation might decrease rates of recurrence and new cases of cannabis use disorder in the course of bipolar disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

The Use of Cannabis as a Predictor of Early Onset of Bipolar Disorder and Suicide Attempts

Neural Plasticity ◽

10.1155/2015/434127 ◽

2015 ◽

Vol 2015 ◽

pp. 1-13 ◽

Cited By ~ 15

Author(s):

Rafaela Torres Portugal Leite ◽

Sarah de Oliveira Nogueira ◽

João Paulo Rodrigues do Nascimento ◽

Laisa Soares de Lima ◽

Taís Bastos da Nóbrega ◽

...

Keyword(s):

Bipolar Disorder ◽

Early Onset ◽

Suicide Attempts ◽

Age At Onset ◽

Prognostic Significance ◽

Manic Episode ◽

Cannabis Use ◽

Pubmed Database ◽

Increased Risk ◽

Bipolar Patients

Introduction. Bipolar disorder (BD) implies risk of suicide. The age at onset (AAO) of BD carries prognostic significance. Substance abuse may precede the onset of BD and cannabis is the most common illicit drug used. The main goal of this study is to review the association of cannabis use as a risk factor for early onset of BD and for suicide attempts.Materials and Methods. PubMed database was searched for articles using key words “bipolar disorder,” “suicide attempts,” “cannabis,” “marijuana,” “early age at onset,” and “early onset.”Results. The following percentages in bipolar patients were found: suicide attempts 3.6–42%; suicide attempts and substance use 5–60%; suicide attempts and cannabis use 15–42%. An early AAO was associated with cannabis misuse. The mean age of the first manic episode in individuals with and without BD and cannabis use disorder (CUD) was 19.5 and 25.1 years, respectively. The first depressive episode was at 18.5 and 24.4 years, respectively. Individuals misusing cannabis showed increased risk of suicide.Discussion. Cannabis use is associated with increased risk of suicide attempts and with early AAO. However, the effect of cannabis at the AAO and suicide attempts is not clear.

Download Full-text

Clinical Characteristics Associated with Suicide Attempt in Patients with Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.293 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S94-S94

Author(s):

M.-E.-M. Vismara ◽

B. Dell’Osso ◽

C. Dobrea ◽

L. Cremaschi ◽

G. Benedetta ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Analysis Of Covariance ◽

Variable Effect ◽

Clinical Variables ◽

Risk Patients ◽

Competing Interest ◽

Bipolar Patients

IntroductionBipolar disorder (BD) is a chronic, highly disabling condition, associated with a high burden of morbidity and mortality, often secondary to suicidal behaviors. In previous reports, different variables have been associated with a higher risk of suicidal acts, with variable effect.ObjectivesTo evaluate which socio-demographic and clinical variables correlate with suicide attempts in bipolar patients.AimsTo enrich literature data about suicidal behaviour in BD.MethodsA sample of 362 BD patients (DSM IV-TR) was retrospectively collected and divided in two subgroups, in relation to the presence of a previous suicide attempt. Socio-demographic and clinical variables were compared between attempters and non-attempters using Corrected multivariate analysis of covariance (MANCOVA).ResultsA total of 26,2% of analyzed patients attempted suicide in their lifespan, and approximately one third of them had multiple suicide attempts (i.e. ≥ 2; 31%). Depressive polarity at index mood episode, higher number of psychiatric hospitalizations, comorbidity with alcohol abuse, eating disorders and psychiatric poly-comorbidity were significantly associated with suicide attempt. Additionally, treatment with lithium, poly-pharmacotherapy (≥ 4 current drugs) and higher recurrence of psychosocial rehabilitation were significantly more frequent in patients who attempted suicide.ConclusionsThe present paper reported a correlation with some specific clinical variables and the lifetime presence of suicide attempt in patients with BD. Although these retrospective findings did not address the causality issue, they may be of clinical relevance in order to better understand suicidal behavior in BD and to adopt proper strategies to prevent suicide in higher risk patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Does psychoeducatioanal Approach Could Reach the Target Patients with Bipolar Disorder?

European Psychiatry ◽

10.1016/s0924-9338(09)70800-4 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

S. Cakir ◽

R. Bensusan ◽

Z. Akca ◽

O. Yazici

Keyword(s):

Bipolar Disorder ◽

Participation Rate ◽

Poor Response ◽

Term Treatment ◽

Recruitment Rate ◽

Mood Stabilizers ◽

Blood Levels ◽

Long Term Treatment ◽

Bipolar Patients

The recurrent nature of bipolar disorder needs an optimum compliance with long term pharmacotherapy, however the poor adherence is common. Adjunctive psychoeducation seems favorable effects on adherence during the long term pharmacotherapy. Even strong benefits were showed, setting a psychoeducation in clinical practice is still novel and recruiting the patients with long history of bipolar disorder may not be feasible. In literature, recruitment rate, motivation and attitudes of patients for participation in psychoeducation is not studied. The present study was conducted to clarify the intends of patients with bipolar disorder to participate in psychoeducation and the factors that contribute.The euthymic patients with diagnosis of bipolar disorder I or II, were invited to the 6 week psychoeducation program in prospective study. The demographic and clinical data were obtained from life charts and updated with a clinical interview. The blood levels of mood stabilizers, adherence, response to prophylactic treatment, relapses and hospitalization rates between the participants and non-participants were compared.84 patients were attended the program, 71 patients were considered as unwilling to attend. The motivation of patients to attend a psychoeducation is limited. The participation rate was only 54.2%. The patients who refused attending to this program have fewer adherences to medication and irregular follow up visits, insufficient blood levels of mood stabilizers, poor response to long term treatment, more likely have mood episodes. Education level between attendees and non-attendees were not different.Optimum methods are required for recruitment of bipolar patients to a psychoeducation program.

Download Full-text

Bipolar disorder and substance use disorders in a Tunisian sample

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.521 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S466-S466

Author(s):

S. Ben Mustapha ◽

W. Homri ◽

R. Labbane

Keyword(s):

Bipolar Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Family Cohesion ◽

Poor Quality ◽

Term Treatment ◽

Response To Treatment ◽

Criminal Records ◽

Long Term Treatment ◽

Bipolar Patients

AimsDescribe the sociodemographic and clinical profile of patients suffering from bipolar disorder and substance use disorders comorbidity and assess the consequences of this comorbidity on prognosis and evolution of bipolar disorder,MethodsA case-control study, 100 euthymic patients treated for bipolar disorder, recruited in the department of psychiatry C of Razi hospital. Two groups of 50 patients were individualized by the presence or not of substance use disorders comorbidity. The two groups were compared for sociodemographic, clinical, therapeutic and historical characteristics.ResultsCompared to bipolar patients without addictive comorbidity, those with this comorbidity had the following characteristics: we found more male, less family cohesion, more domestic violence, more criminal records, more time spent abroad, more personality disorders especially antisocial and borderline, fewer triggers of bipolar illness, more mood episodes, more psychotic features, higher impulsivity BIS-10 score, an increased need to put in a neuroleptic long term treatment, poor adherence to treatment, lower response to treatment, lower score of global assessment of functioning (GAF), more rapid cycles, shorter period of remission, longer duration of the last mood episode, poor socio-professional integration and poor quality of intervals between mood episodes.ConclusionsIt seems important to insist on the identification and the treatment of bipolar disorder or substance use disorders when one of them is diagnosed. This needs to set up urgently facilities and care structures for patients with substance use disorders and to create more addiction consultations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Outcome of Bipolar Disorder on Long-Term Treatment with Lithium

The British Journal of Psychiatry ◽

10.1192/bjp.159.1.123 ◽

1991 ◽

Vol 159 (1) ◽

pp. 123-129 ◽

Cited By ~ 224

Author(s):

Ralph A. O'Connell ◽

Julia A. Mayo ◽

Leslie Flatow ◽

Beverly Cuthbertson ◽

Barbara E. O'Brien

Keyword(s):

Bipolar Disorder ◽

Treatment Outcome ◽

Lithium Treatment ◽

Term Treatment ◽

Poor Outcome ◽

Psychiatric Admissions ◽

Long Term Treatment ◽

Alcohol And Drug Abuse ◽

Bipolar Patients

The long-term treatment outcome of 248 bipolar patients in an out-patient lithium programme was assessed. Over half of the patients (138 or 56%) had no affective episodes in the year observed. Patients were divided into outcome groups according to GAS scores: the outcome for 40% of patients was good, for 41% fair, and for 19% poor. More frequent psychiatric admissions before starting lithium treatment was the best predictor of poor outcome, followed by a negative affective style in the family and lower social class. Current alcohol and drug abuse was associated with poor outcome. Although familial and psychosocial factors were significantly associated with outcome, the findings suggest there may be inherent differences in the pathophysiology of bipolar disorder reflected in an increased frequency of episodes which account for a large variance in lithium treatment outcome.

Download Full-text

The characteristic of auditory hallucinations in patients with schizophrenia, schizoaffective and bipolar disorder with psychotic features in Iran

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1457 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S403-S404

Author(s):

S.M. Zamir ◽

S.A. Haji Seyed Javadi ◽

M. Majidi

Keyword(s):

Bipolar Disorder ◽

Schizoaffective Disorder ◽

Medical Science ◽

Auditory Hallucinations ◽

University Hospital ◽

Fourth Decade ◽

Competing Interest ◽

Bipolar Patients ◽

Psychotic Features ◽

Hospital Psychiatry

IntroductionAuditory hallucinations are perceptional experiments that occur in schizophrenia, schizoaffective disorder and bipolar disorder with psychotic features. Characteristic of these hallucinations may have relation with cultural factors.AimWe have done this study to understand more about content and characteristic of auditory hallucinations in Schizophrenia, schizoaffective and bipolar disorder with psychotic features in Qazvin, a state in north-center of Iran.MethodsWe used the questionnaire that prof. Romme and Escher developed in 1987 for research purposes. Sixty patients diagnosed with schizophrenia, schizoaffective and bipolar disorder with psychotic features that admitted or attended at clinic of Qazvin medical science university hospital, psychiatry ward, were interviewed.ResultsThe 45 men and 15 women in three groups were interviewed. The most were men, single, and in fourth decade of their life. Most patients mentioned that they heard one voice. Mean age of appearing voices in patients were 19 to 29 years old. Most patients in the schizoaffective and bipolar group heard male voices and in schizophrenia were both sexes. Eighty-five percent of bipolar patients, 65% of patients with schizoaffective disorder heard friendly voices. It was 30% in patients with schizophrenia. Fifteen percent of bipolar patients, 75% of schizophrenia and 45% of schizoaffective stated that voice was hostile.ConclusionOur study has revealed that culture affected content and characteristic of auditory hallucinations. We suggested that some complementary studies will be done in future from different Iranian cultures not just people of Qazvin.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text