title: Substance abuse in first-episode bipolar I disorder: indications for early intervention.
abstract: OBJECTIVE
  This study clarified the early characteristics of substance use disorders in patients with first-episode bipolar I disorder.
  
  
  METHODS
  The authors evaluated substance use disorders, associated factors, and clinical course, prospectively, in the first 2 years of DSM-IV bipolar I disorder with standardized methods.
  
  
  RESULTS
  Baseline substance use disorder was found in 33% (37 of 112) of the patients at baseline and in 39% at 24 months. Anxiety disorders were more frequent in the patients with than without substance use disorder (30% and 13%, respectively). Associations of alcohol dependence with depressive symptoms and cannabis dependence with manic symptoms were suggested. Patients using two or more substances had worse outcomes.
  
  
  CONCLUSIONS
  Since substance use disorders were frequent from the beginning of bipolar I disorder and were associated with anxiety disorders and poor outcome, early interventions for substance use disorder and anxiety might improve later outcome.
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA. cbaethge@mclean.harvard.edu
authors.forename: Christopher
authors.initials: C
authors.lastname: Baethge
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
authors.forename: Hari-Mandir Kaur
authors.initials: HM
authors.lastname: Khalsa
authors.forename: John
authors.initials: J
authors.lastname: Hennen
authors.forename: Paola
authors.initials: P
authors.lastname: Salvatore
authors.forename: Mauricio
authors.initials: M
authors.lastname: Tohen
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy