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 Posted - 06/05/2005 : 19:51:11
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Hi Aqua,
Research has shown that individuals with Bipolar I Disorder are at high risk of developing alcohol and drug addiction. Successful treatment of Bipolar Disorder has been shown to decrease the associated alcohol and drug addiction.
Phil Long M.D.
Administrator 
Arch Gen Psychiatry. 2005 Jan;62(1):37-45.
Efficacy of valproate maintenance in patients with bipolar disorder and alcoholism: a double-blind placebo-controlled study.
Salloum IM, Cornelius JR, Daley DC, Kirisci L, Himmelhoch JM, Thase ME.
Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center and School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA.
BACKGROUND: More than half of all individuals with bipolar disorder have a substance abuse problem at some point in their lifetime. Patients with comorbid substance abuse disorders often are excluded from clinical trials. Thus, treatments targeting this high-risk clinical population are lacking. OBJECTIVE: To evaluate the efficacy of divalproex sodium (hereafter referred to as valproate) in decreasing alcohol use and stabilizing mood symptoms in acutely ill patients with bipolar disorder and alcoholism. DESIGN: A 24-week, double-blind, placebo-controlled, randomized parallel-group trial. SETTING: A university hospital serving as a primary catchment-area hospital and tertiary-care facility. PARTICIPANTS: Fifty-nine subjects with diagnoses of bipolar I disorder and alcohol dependence.Intervention All study subjects received treatment as usual, including lithium carbonate and psychosocial interventions, and were randomized to receive valproate or placebo. MAIN OUTCOME MEASURES: Primary alcohol use outcomes included changes in alcohol use as indicated by changes in proportion of heavy drinking days and number of drinks per heavy drinking day. Other alcohol use outcomes included proportion of any drinking days, number of drinks per drinking day, and relapse to sustained heavy drinking. Mood outcomes included changes in depressive and manic symptoms. We used the mixed model to analyze longitudinal data. The first model used time of assessment, bipolar subtype (mixed, manic, or depressed), and treatment group (placebo or valproate) as covariates. The second nested model included the additional covariate of medication adherence. RESULTS: The valproate group had a significantly lower proportion of heavy drinking days (P = .02) and a trend toward fewer drinks per heavy drinking day (P = .055) than the placebo group. When medication adherence was added as covariate, the valproate group had significantly fewer drinks per heavy drinking day (P = .02) and fewer drinks per drinking day (P = .02). Higher valproate serum concentration significantly correlated with improved alcohol use outcomes. Manic and depressive symptoms improved equally in both groups. Level of gamma-glutamyl transpeptidase was significantly higher in the placebo group compared with the valproate group. CONCLUSIONS: Valproate therapy decreases heavy drinking in patients with comorbid bipolar disorder and alcohol dependence. The results of this study indicate the potential clinical utility of the anticonvulsant mood stabilizer, valproate, in bipolar disorder with co-occurring alcohol dependence.
PMID: 15630071
Am J Psychiatry. 2003 May;160(5):883-9.
Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder.
Frye MA, Altshuler LL, McElroy SL, Suppes T, Keck PE, Denicoff K, Nolen WA, Kupka R, Leverich GS, Pollio C, Grunze H, Walden J, Post RM.
Department of Psychiatry and Biobehavioral Sciences, UCLA Bipolar Research Program, University of California-Los Angeles School of Medicine, 300 UCLA Medical Plaza, Suite 1544, Los Angeles, CA 90095, USA. mfrye@mednet.ucla.edu
OBJECTIVE: The prevalence of lifetime alcohol abuse and/or dependence (alcoholism) in patients with bipolar disorder has been reported to be higher than in all other axis I psychiatric diagnoses. This study examined gender-specific relationships between alcoholism and bipolar illness, which have previously received little systematic study. METHOD: The prevalence of lifetime alcoholism in 267 outpatients enrolled in the Stanley Foundation Bipolar Network was evaluated by using the Structured Clinical Interview for DSM-IV. Alcoholism and its relationship to retrospectively assessed measures of the course of bipolar illness were evaluated by patient-rated and clinician-administered questionnaires. RESULTS: As in the general population, more men (49%, 57 of 116) than women with bipolar disorder (29%, 44 of 151) met the criteria for lifetime alcoholism. However, the risk of having alcoholism was greater for women with bipolar disorder (odds ratio=7.35) than for men with bipolar disorder (odds ratio=2.77), compared with the general population. Alcoholism was associated with a history of polysubstance use in women with bipolar disorder and with a family history of alcoholism in men with bipolar disorder. CONCLUSIONS: This study suggests that there are gender differences in the prevalence, risk, and clinical correlates of alcoholism in bipolar illness. Although this study is limited by the retrospective assessment of illness variables, the magnitude of these gender-specific differences is substantial and warrants further prospective study.
PMID: 12727691
Bipolar Disord. 2002 Dec;4(6):418-21.
Impact of concurrent alcohol misuse on symptom presentation of acute mania at initial evaluation.
Salloum IM, Cornelius JR, Mezzich JE, Kirisci L.
Center for Psychiatric and Chemical Dependency Services, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213, USA. salloumim@msx.upmc.edu
OBJECTIVES: The aim of this study was to evaluate the impact of current alcohol misuse on symptom presentation of acute mania. METHODS: The impact of concurrent alcohol misuse on symptom presentation of acute mania was examined by comparing comorbid subjects with acute bipolar mania complicated by current alcohol misuse (n=60) with subjects with acute bipolar mania without current alcohol misuse (n=196). RESULTS: Age- and gender-controlled analysis revealed that the comorbid group presented with more severe psychopathology, as indicated by higher number of total mood-related symptoms as well as of higher total number of manic symptoms. Specifically, they presented with significantly higher rates of mood lability and impulsivity, and also demonstrated higher rates of violent behavior, and other drug use. CONCLUSIONS: Acute mania complicated by current alcohol misuse is differentiated from acute mania without alcohol misuse by the presence of higher numbers of manic symptoms and increased high risk behavior such as mood lability, impulsivity, violence, and other drug abuse.
PMID: 12519103
Addict Behav. 2001 May-Jun;26(3):341-8.
Characterizing female bipolar alcoholic patients presenting for initial evaluation.
Salloum IM, Cornelius JR, Mezzich JE, Kirisci L, Daley DC, Spotts CR, Zuckoff A.
Center for Psychiatric and Chemical Dependency Services, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, PA 15213, USA. salloumim@msx.upmc.edu
This study examined gender differences of age and race-matched group of bipolar disorder (BPO) patients with comorbid alcohol dependence (AD; n = 65; males = 35, females = 30) to a group of BPO patients without comorbid AD (n = 61; males = 22, females = 39). The two groups were also similar on marital status and frequency of BPO subtypes. The results revealed that female bipolar alcoholic patients were more likely to report depressive symptoms as compared to either male bipolar alcoholics or both male and female non-alcoholic bipolar patients. When compared to male bipolar alcoholics, they had higher frequency of depressed mood, slow motor behavior, low self-esteem, decreased libido, decreased appetite, and higher general anxiety symptoms. On the other hand, female bipolar alcoholics differed from female non-alcoholic bipolar patients on reports of mood lability, depressed mood, low self-esteem, suicidal indicators, decreased libido, and general anxiety symptoms. These results raise the question of whether alcohol increases the frequency of depressive symptoms among female bipolar patients.
PMID: 11436926
J Affect Disord. 1999 Apr;53(1):49-55.
The effect of comorbid alcoholism on recurrence in affective disorder: a case register study.
Kessing LV.
Department of Psychiatry, University of Copenhagen, Rigshopitalet, Denmark.
BACKGROUND: Studies of the effect of comorbid alcoholism on the risk of recurrence in affective disorder have given contradictory results. METHOD: Using survival analysis, the rate of recurrence was calculated in a case register study including all hospital admissions with primary affective disorder in Denmark during 1971-1993. The rate of recurrence was estimated following each new affective episode. RESULTS: In all, 20 350 patients were discharged after first admission with a main diagnosis of affective disorder of depressive or manic/circular type. Among these, 518 patients (2.6%) had an auxiliary diagnosis of alcoholism. Patients with a current auxiliary diagnosis of alcoholism had increased rate of recurrence following the first three affective episodes but not following subsequent episodes compared with patients without auxiliary diagnoses. The effect of alcoholism declined with the number of episodes. In contrast, no effect was found of other auxiliary diagnoses on the rate of recurrence. CONCLUSION: Rehospitalisation data suggest that concurrent alcoholism increases the risk of recurrence of affective episodes during the initial course of unipolar and bipolar disorder but has no effect on recurrence later in the course of the illnesses. LIMITATION: The data relate to re-admissions rather than recurrence. CLINICAL RELEVANCE: The study emphasises that alcoholism has a deteriorating effect on the course of affective disorder.
PMID: 10363666
Arch Gen Psychiatry. 1998 Jan;55(1):41-6.
Cognitive impairment in euthymic bipolar patients with and without prior alcohol dependence. A preliminary study.
van Gorp WG, Altshuler L, Theberge DC, Wilkins J, Dixon W.
Department of Psychiatry, Cornell University Medical College, White Plains, NY, USA. wvangorp%westnyh@nyh.med.cornell.edu
BACKGROUND: Few studies of the neurocognitive performance of patients with bipolar disorder have been performed while patients are in the euthymic state. METHODS: Twenty-five euthymic bipolar patients (12 with and 13 without a history of alcohol dependence) were compared with 22 normal control subjects on a neuropsychological test battery assessing a range of cognitive domains. The relationship between subjects' neurocognitive performance and the course-of-illness variables (lifetime episodes and duration of mania, depression, or both), as well as current lithium level, was determined. RESULTS: The results indicated differences across the groups, with the bipolar patients with and without alcohol dependence performing more poorly than controls on tests of verbal memory. Furthermore, bipolar subjects with a history of alcohol dependence had additional decrements in executive (i.e., frontal lobe) functions when compared with controls. For subjects in the bipolar group, lifetime months of mania and depression were negatively correlated with performance in verbal memory and several executive function measures. CONCLUSIONS: Our findings support the presence of persistent neurocognitive difficulties in patients with long-standing bipolar disorder who are not in the psychiatrically acute state or who are suffering the effects of alcohol abuse and suggest that there may be an aggregate negative effect of lifetime duration of bipolar illness on memory and frontal or executive systems.
PMID: 9435759
Am J Med Genet. 1996 Apr 9;67(2):197-201.
Familial alcoholism in manic-depressive (bipolar) disease.
Winokur G, Coryell W, Endicott J, Keller M, Akiskal H, Solomon D.
National Institute of Mental Health Collaborative Program on the Psychobiology of Depression, Clinical Studies, Washington, DC, USA.
A previous analysis found a relatively high rate of alcoholism in a cohort of bipolar I subjects, and a trend for increased rates of alcoholism in relatives of subjects with both bipolar I disorder and alcoholism, compared to relatives of subjects with bipolar I disorder and no alcoholism. The sample of subjects with bipolar I disorder has been enlarged through continued follow-up, permitting new analyses to address the association and heritability of bipolar I disorder with alcoholism. Probands with bipolar I disorder were followed for 10 years as part of the NIMH Collaborative Depression Study. The rate of alcoholism in relatives of probands with both bipolar I disorder and alcoholism was compared to the rate of alcoholism in relatives of probands with bipolar disorder and no alcoholism. The prevalence of alcoholism in relatives of subjects with bipolar I disorder was compared to the rate of alcoholism in relatives of control subjects. Relatives of probands with bipolar I disorder showed a higher rate of alcoholism than relatives of controls. Relatives of probands with bipolar I disorder and alcoholism showed a higher rate of alcoholism than relatives of probands with bipolar I disorder without alcoholism. These data suggest that familial alcoholism may contribute to a vulnerability to bipolar I disorder, and that there is a shared heritability for the two disorders.
PMID: 8723047 |
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Epival and alcohol and liver function
