scholarly journals A Prospective Comparison of Bipolar I and II Subjects With and Without Comorbid Alcohol Dependence From the COGA Dataset

2020 ◽  
Vol 11 ◽  
Author(s):  
Ulrich W. Preuss ◽  
M. N. Hesselbrock ◽  
V. M. Hesselbrock
Keyword(s):  
Bipolar Disorder ◽  
Alcohol Use ◽  
Alcohol Dependence ◽  
Collaborative Study ◽  
Structured Interviews ◽  
Prospective Comparison ◽  
Bipolar Ii ◽  
Bipolar Patients ◽  
Alcohol Dependent

Objective: Comorbidity of alcohol use disorders in bipolar subjects is high as indicated by epidemiological and clinical studies. Though a more severe course of bipolar disorder in subjects with comorbid alcohol dependence has been reported, fewer studies considered the longitudinal course of alcohol dependence in bipolar subjects and the prospective course of comorbid bipolar II subjects. Beside baseline analysis, longitudinal data of the COGA (Collaborative Study on Genetics in Alcoholism) were used to evaluate the course of bipolar I and II disordered subjects with and without comorbid alcohol dependence over more than 5 years of follow-up.Methods: Characteristics of bipolar disorder, alcohol dependence and comorbid psychiatric disorders were assessed using semi-structured interviews (SSAGA) at baseline and at a 5-year follow-up. Two hundred twenty-eight bipolar I and II patients were subdivided into groups with and without comorbid alcohol dependence.Results: Of the 152 bipolar I and 76 bipolar II patients, 172 (75, 4%) had a comorbid diagnosis of alcohol dependence. Bipolar I patients with alcohol dependence, in particular women, had a more severe course of bipolar disorder, worse social functioning and more suicidal behavior than all other groups of subjects during the 5-year follow-up. In contrast, alcohol dependence improved significantly in both comorbid bipolar I and II individuals during this time.Conclusions: A 5-year prospective evaluation of bipolar patients with and without alcohol dependence confirmed previous investigations suggesting a more severe course of bipolar disorder in comorbid bipolar I individuals, whereas bipolar II individuals were less severely impaired by comorbid alcohol use disorder. While severity of alcohol dependence improved during this time in comorbid alcohol-dependent bipolar I patients, the unfavorable outcome for these individuals might be due to the higher comorbidity with personality and other substance use disorders which, together with alcohol dependence, eventually lead to poorer symptomatic and functional clinical outcomes.

Clinical and prognostic implications of seasonal pattern in bipolar disorder: a 10-year follow-up of 302 patients

2007 ◽  
Vol 37 (11) ◽  
pp. 1595-1599 ◽  
Author(s):  
J. M. GOIKOLEA ◽  
F. COLOM ◽  
A. MARTÍNEZ-ARÁN ◽  
J. SÁNCHEZ-MORENO ◽  
A. GIORDANO ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Seasonal Pattern ◽  
Psychotic Symptoms ◽  
Stepwise Logistic Regression ◽  
Structured Interviews ◽  
Bipolar Ii Disorder ◽  
Bipolar Ii ◽  
Long Term Follow Up ◽  
Bipolar Patients

ABSTRACTBackgroundMore than 20% of bipolar patients may present with seasonal pattern (SP). Seasonality can alter the course of bipolar disorder. However, to date, long-term follow-up studies of bipolar patients presenting with SP are scarce. We present a 10-year follow-up study comparing clinical and demographic features of bipolar patients with and without SP.MethodThree hundred and twenty-five bipolar I and II patients were followed up for at least 10 years. SP was defined according to DSM-IV criteria. Clinical variables were obtained from structured interviews with the patients and their relatives. Patients with and without SP were compared regarding clinical and sociodemographic variables and a stepwise logistic regression was performed.ResultsSeventy-seven patients (25·5%) were classified as presenting with SP, while 225 (74·5%) were considered as presenting with no significant seasonal variation. Twenty-three patients (7%) were excluded from the study because it was unclear whether they had seasonality or not. There were no differences between groups regarding demographic variables. Patients with SP predominantly presented with bipolar II disorder, depressive onset, and depressive predominant polarity. The greater burden of depression did not correlate with indirect indicators of severity, such as suicidality, hospitalizations or psychotic symptoms.ConclusionsOur study links the presence of SP with both bipolar II disorder and predominant depressive component. However, we could not find any difference regarding functionality or hospitalization rates. Modifications in the criteria to define SP are suggested for a better understanding of bipolar disorder.

scholarly journals PP029 Hospitalizations And Costs In Bipolar Disorder Patients Initiating Long-acting Injectable Antipsychotics

2017 ◽  
Vol 33 (S1) ◽  
pp. 83-83
Author(s):  
Mallik Greene ◽  
Tingjian Yan ◽  
Eunice Chang ◽  
Ann Hartry ◽  
Michael Broder
Keyword(s):  
Bipolar Disorder ◽  
Reference Group ◽  
Cohort Analysis ◽  
Linear Regression Models ◽  
Inpatient Hospitalization ◽  
Inpatient Hospitalizations ◽  
Long Acting ◽  
Bipolar Patients ◽  
The Impact

INTRODUCTION:Existing studies have not investigated the effectiveness of one long-acting injectable antipsychotic (LAI) versus another in preventing hospitalizations among patients with bipolar disorder (BD). This study was conducted to compare all-cause inpatient healthcare utilization and associated costs among BD patients who initiated LAIs.METHODS:This retrospective cohort analysis used the Truven Health Analytics MarketScan® Commercial and Medicaid claims database. Bipolar patients >18 years with at least one claim for one of the following LAIs were identified between 1 January 2013 and 30 June 2014 (identification period): aripiprazole, haloperidol, paliperidone, and risperidone. The first day of initiating an LAI was considered the index date. Logistic regression and generalized linear regression models were conducted to estimate risk of inpatient hospitalization and associated costs during the 1-year follow up.RESULTS:A total of 1,540 BD patients initiated an LAI: 14.5 percent aripiprazole, 16.3 percent risperidone, 21.0 percent haloperidol, and 48.1 percent paliperidone. With the aripiprazole cohort as the reference group, the odds of having any inpatient hospitalizations were significantly higher in haloperidol [Odds Ratio, OR (95 percent Confidence Interval, CI): 1.49 (1.01 - 2.19)] and risperidone [1.78 (1.19 - 2.66)] cohorts. The paliperidone cohort also had a higher risk of having a hospitalization than aripiprazole, but the difference was not statistically significant (p>.05). Among LAI initiators having any inpatient hospitalizations, the adjusted mean all-cause inpatient costs were lowest in the aripiprazole cohort (USD26,002), followed by risperidone (USD27,937), haloperidol (USD30,411), and paliperidone (USD33,240). However, the cost difference was not statistically significant.CONCLUSIONS:Our study findings highlight the value of aripiprazole in reducing all-cause inpatient hospitalizations and associated costs among patients with BD during the 1-year follow-up. It is worthwhile to note that bipolar diagnoses were identified from healthcare claims coded for reimbursement purposes, thus misclassification was possible. Future studies are warranted to understand the impact of LAI use in a longer period of time.

scholarly journals A 22-Year Follow-Up (Range 16 to 23) of Original Subjects with Baseline Alcohol Use Disorders from the Collaborative Study on Genetics of Alcoholism

2018 ◽  
Vol 42 (9) ◽  
pp. 1704-1714 ◽  
Author(s):  
Marc A. Schuckit ◽  
Tom L. Smith ◽  
George Danko ◽  
John Kramer ◽  
Kathleen K. Bucholz ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Alcohol Use Disorders ◽  
Collaborative Study

scholarly journals Deficits of Prospective Capacity as Possible Mechanism in Pathogenesis of Alcohol Dependence

2019 ◽  
Vol 27 (1) ◽  
pp. 79-101 ◽  
Author(s):  
O.D. Tuchina ◽  
D.I. Shustov ◽  
T.V. Agibalova ◽  
S.A. Shustova
Keyword(s):  
Alcohol Dependence ◽  
Adult Children Of Alcoholics ◽  
Clinical Case ◽  
Alcohol Intoxication ◽  
Children Of Alcoholics ◽  
Structured Interviews ◽  
Outpatient Psychotherapy ◽  
Psychological Mechanisms ◽  
Clinical Case Studies ◽  
Alcohol Dependent

The article presents a taxonomy of prospective capacity (PC) relying on the up-to-date understanding of its neurobiological and psychological mechanisms. The rationale for the existence of a dissociation between adaptive and maladaptive manifestations of explicit and implicit forms of PC rests on a study of clinical cases of alcohol-dependent patients (N=5) and adult children of alcoholics (N=1), who ap plied for outpatient psychotherapy of alcohol dependence or related issues. The patients underwent specific semi-structured interviews (Shustov et al., 2000; Johnsson, 2011); completed the Life Line method (Nurkova, 2000) and compiled genograms (McGoldrick et al, 2008). Based on the findings of clinical case studies, the authors have proposed that alcohol-dependent patients’ PC deficits that aggravate the course of alcohol dependence may relate to the existence of socially and culturally bound automatic prospective schemata, i.e. scripts that relate to specific states of self and actualize under uncertainty, stress and/or alcohol intoxication.

scholarly journals The relationship between borderline personality disorder and bipolar disorder

2013 ◽  
Vol 15 (2) ◽  
pp. 155-169 ◽  
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Borderline Personality ◽  
Bipolar Spectrum ◽  
Bipolar Ii ◽  
Axis I ◽  
Bipolar Patients ◽  
The Relationship

It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum.

scholarly journals Efficacy of acamprosate in the treatment of alcohol-dependent outpatients

2003 ◽  
Vol 25 (3) ◽  
pp. 156-159 ◽  
Author(s):  
Danilo Antonio Baltieri ◽  
Arthur Guerra de Andrade
Keyword(s):  
Side Effects ◽  
Alcohol Dependence ◽  
Placebo Treatment ◽  
Controlled Study ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Continuous Abstinence ◽  
Icd 10 ◽  
Alcohol Dependent

OBJECTIVE: To evaluate the efficacy and security of acamprosate in the treatment of 75 men, aged 18 to 59 years, with diagnosis of alcohol dependence according to the ICD-10. METHODS: Double-blind, placebo-controlled study, 24-week long. After a one-week detoxification period, patients were randomly divided in two groups: the first group received acamprosate (six tablets of 333 mg/d for 12 weeks) and the second group received placebo (six tablets for 12 weeks). After the first 12 weeks, patients continued the follow-up for further 12 weeks without medication. RESULTS: Patients who were receiving acamprosate showed significantly higher continuous abstinence time within the 24 weeks of treatment compared with patients who were assigned to placebo treatment (p=.017). Twenty-five percent of patients who were receiving acamprosate and 20% of the placebo-treated patients dropped out. Few side-effects were reported in both groups. CONCLUSION: Acamprosate proved to be safe and effective in treating alcohol-dependent patients and to maintain the abstinence during 24 weeks.

Reduced-risk drinking as a viable treatment goal in problematic alcohol use and alcohol dependence

2013 ◽  
Vol 27 (11) ◽  
pp. 987-997 ◽  
Author(s):  
Jan van Amsterdam ◽  
Wim van den Brink
Keyword(s):  
Alcohol Use ◽  
Alcohol Dependence ◽  
Empirical Support ◽  
Additional Treatment ◽  
Treatment Goal ◽  
Added Value ◽  
Problematic Alcohol ◽  
Problematic Alcohol Use ◽  
Reduced Risk

This review describes and discusses studies related to reduced-risk drinking as an additional treatment option for patients with problematic alcohol use and alcohol dependence. The review provides some empirical support for the following statements: (a) reduced-risk drinking is a viable option for at least some problem and dependent drinkers; (b) abstinence and non-abstinence-based treatments appear to be equally effective; (c) allowing patients to choose their treatment goal increases the success rate. The relatively short follow-up period (1–2 years) of the studies hampers a proper evaluation of the added value of the reduced-risk drinking approach.

Biochemical and genetic markers in patients with alcohol dependence and affective disorders and their correlation with alcohol intake

2016 ◽  
Vol 33 (S1) ◽  
pp. S19-S20
Author(s):  
U. Preuss ◽  
F. Wurst
Keyword(s):  
Alcohol Use ◽  
Alcohol Dependence ◽  
Affective Disorders ◽  
Alcohol Intake ◽  
Bipolar Disorders ◽  
Cross Sectional Study ◽  
Emergency Rooms ◽  
Higher Alcohol ◽  
Cross Sectional ◽  
Alcohol Dependent

Rates of comorbid affective disorders in alcohol-dependent individuals are significant. Biomarkers of alcohol use may support the diagnosis of high and frequent alcohol use in these individuals. The aim of these analyses of the WHO-ISBRA Study on State and Trait Markers of Alcohol Use and Dependence is to compare biomarkers of alcohol use across individuals with and without comorbid alcohol dependence and affective disorders. Significantly, higher values of these biomarkers are hypothesized in individuals with comorbid disorders compared to alcohol dependence only. Assessment of Alcohol dependence and comorbid depression and bipolar disorders were conducted using an adapted version of the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS). Altogether, n = 1863 individuals were included into the analyses, of whom n = 299 had a lifetime history of depression and n = 20 a bipolar disorder. Clinical characteristics like mean alcohol intake last month and biomarkers including ASAT, GGT, CDT, 5-HTOL/5-HIAA ratio and MAO-Activity were included into the analyses. Results indicate that AD only subjects had higher measures of all biomarkers compared to comorbid bipolar and depression subjects, while the latter had a higher alcohol intake during last month.Since this is a cross-sectional study, conducted in emergency rooms of several countries, this allegedly divergent result in alcohol intake in comorbid subjects compared to higher biomarkers in AD only subjects may indicate that drinking is more frequent in alcohol-dependent individuals while bipolar and depressed subjects may have more episodic pattern of alcohol intake. The latter may lead to shorter periods of intake compared to the chronic and frequent use of this substance in alcohol-dependent individuals and higher biomarkers of alcohol use.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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