Aggression and substance abuse in bipolar disorder.
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.
Grunebaum
Michael F
MF
Department of Neuroscience, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA. mfg14@columbia.edu
Galfalvy
Hanga C
HC
Nichols
C Matthew
CM
Caldeira
Nathilee A
NA
Sher
Leo
L
Dervic
Kanita
K
Burke
Ainsley K
AK
Mann
J John
JJ
Oquendo
Maria A
MA
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