title: Aggression and substance abuse in bipolar disorder.
abstract: OBJECTIVE
  The goal of this retrospective study was to examine factors differentiating persons with bipolar disorder who did or did not have comorbid lifetime substance use disorders (SUD) at an index assessment. We also explored the chronology of onset of mood and SUD.
  
  
  METHODS
  We studied 146 subjects with DSM-defined bipolar disorder. Subgroups with and without lifetime SUD were compared on demographic and clinical measures.
  
  
  RESULTS
  Substance abuse disorders in this bipolar sample were associated with male sex, impulsive-aggressive traits, comorbid conduct and Cluster B personality disorders, number of suicide attempts and earlier age at onset of a first mood episode. In a multivariable logistic regression analysis, male sex and aggression and possibly earlier age at mood disorder onset were associated with SUD. In those with or without SUD, the first mood episode tended to be depressive and to precede the onset of SUD.
  
  
  CONCLUSIONS
  In persons with bipolar disorder, an earlier age of onset and aggressive traits appear to be factors associated with later development of comorbid SUD.
authors.affiliation: Department of Neuroscience, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA. mfg14@columbia.edu
authors.forename: Michael F
authors.initials: MF
authors.lastname: Grunebaum
authors.forename: Hanga C
authors.initials: HC
authors.lastname: Galfalvy
authors.forename: C Matthew
authors.initials: CM
authors.lastname: Nichols
authors.forename: Nathilee A
authors.initials: NA
authors.lastname: Caldeira
authors.forename: Leo
authors.initials: L
authors.lastname: Sher
authors.forename: Kanita
authors.initials: K
authors.lastname: Dervic
authors.forename: Ainsley K
authors.initials: AK
authors.lastname: Burke
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000374:Aggression / Q000523:psychology*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D019955:Conduct Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009518:New York; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D012189:Retrospective Studies; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data