Comorbid anxiety and substance use disorders associated with a lower use of mood stabilisers in patients with rapid cycling bipolar disorder: a descriptive analysis of the cross-sectional data of 566 patients

Authors

  • K. Gao,

    1. Department of Psychiatry, Mood & Anxiety Clinic at Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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  • D. E. Kemp,

    1. Department of Psychiatry, Mood & Anxiety Clinic at Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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  • C. Conroy,

    1. Department of Psychiatry, Mood & Anxiety Clinic at Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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  • S. J. Ganocy,

    1. Department of Psychiatry, Mood & Anxiety Clinic at Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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  • R. L. Findling,

    1. Department of Psychiatry, Mood & Anxiety Clinic at Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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  • J. R. Calabrese

    1. Department of Psychiatry, Mood & Anxiety Clinic at Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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  • Disclosures Dr Calabrese has received grant support from the National Institute of Mental Health and the Stanley Medical Research Institute. He has also received grant support and/or honoraria from Abbott, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Pfizer and Janssen. 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, Organon, Otsuka, Pfizer, Sanofi-Aventis, Sepracore, Shire, Solvay, Supernus Pharmaceuticals, Validus and Wyeth. Dr Gao received research grants from, NARSAD, and AstraZeneca, Morley Family Fund of Cleveland and served on an advisory board of Schering-Plough. Dr Kemp has acted as a consultant to BMS and is on the speaker’s bureau for Astra-Zeneca and Pfizer, has received research support from NARSAD and the International Society for Bipolar Disorders and has received research support in the form of study medication from Takeda.

Keming Gao, MD, PhD, 10524 Euclid Avenue, 12th Floor, Cleveland, OH 44106, USA
Tel.: + 1 216 844 2656
Fax: + 1 216 844 2875
Email: keming.gao@uhhospitals.org

Summary

Objective:  To study mood stabiliser treatment in patients with bipolar disorder with or without anxiety disorders (ADs) and/or substance use disorders (SUDs).

Methods:  Extensive clinical interview and Mini-International Neuropsychiatric Interview were used to ascertain DSM-IV diagnoses of rapid cycling bipolar I (RCBDI) or II (RCBDII), SUDs and ADs. Previous treatment statuses with a mood stabiliser after the first onset of mania/hypomania (unmedicated, mismedicated and correctly medicated) were retrospectively determined in patients enrolled into four similar clinical trials. T-test and chi-square/Fisher’s exact were used wherever appropriate.

Results:  Of 566 patients (RCBDI n = 320, RCBDII n = 246), 46% had any lifetime AD, 67% had any lifetime SUD and 40% had any recent SUD. Overall, 12% of patients were unmedicated, 37% were mismedicated at the onset of first mania/hypomania and 51% were correctly medicated. Presence of lifetime ADs and recent SUDs was associated with fewer mood stabiliser treatments. Patients with RCBDI were more likely correctly medicated than those with RCBDII (OR = 3.64) regardless of the presence (OR = 2.6) or absence (OR = 4.2) of ADs, or the presence (OR = 2.8) or absence (OR = 3.13) of recent SUDs. Presence of lifetime ADs and recent SUDs increased the risk for mismedicated in RCBDI with odds ratios of 1.8 and 1.9, respectively, but not in RCBDII.

Conclusion:  In this multi-morbid cohort of patients with RCBD, 51% of patients (64% of RCBDI and 33% with RCDBII) were correctly medicated with a mood stabiliser after the onset of first mania/hypomania. The presence of ADs and SUDs was associated with an increased risk of mismedicated in patients with RCBDI, but not with RCBDII.

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