Clinical correlates of patients with rapid-cycling bipolar disorder and a recent history of substance use disorder: a subtype comparison from baseline data of 2 randomized, placebo-controlled trials.
OBJECTIVE
To compare clinical variables in patients with rapid-cycling bipolar I or II disorder and a recent history of substance use disorder (SUD).


METHODS
Cross-sectional data from 2 studies of patients with rapid-cycling bipolar I disorder or rapid-cycling bipolar II disorder and a recent history of SUD were used to retrospectively assess the differences in clinical variables between the subtypes. The studies were conducted from November 1997 to February 2007 at University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. Extensive clinical interview and the Mini-International Neuropsychiatric Interview were used to ascertain DSM-IV diagnoses of rapid-cycling bipolar disorder, SUDs, and other Axis I disorders and to collect clinical variables. The Addiction Severity Index (ASI), Global Assessment Scale (GAS), and the Medical Outcomes Study 36-Item Short-Form Health Survey were used to measure the severity of impairment at the initial assessment. One-way analysis of variance or chi(2) was used for significance tests. A Bonferroni adjustment was applied for multiple comparisons.


RESULTS
Of 245 patients with rapid-cycling bipolar disorder (rapid-cycling bipolar I disorder, N = 191; rapid-cycling bipolar II disorder, N = 54) and a recent history of SUD, the demographics were similar. A significantly higher rate of panic disorder was observed in patients with rapid-cycling bipolar I disorder than in those with rapid-cycling bipolar II disorder (odds ratio = 3.72, 95% CI = 1.66 to 8.32, p = .008). A significantly higher psychiatric composite score on the ASI was also found in patients with rapid-cycling bipolar I disorder than in those with rapid-cycling bipolar II disorder even after Bonferroni adjustment (p = .0007). There were no significant differences between the subtypes in the rates of previous hospitalization or suicide attempt, early childhood verbal, physical, or sexual abuse, lifetime substance abuse or dependence, the number of SUDs or mood episodes in the last 12 months, and total or other subscale scores on ASI and GAS.


CONCLUSIONS
Except for the significantly higher rate of comorbid panic disorder and higher psychiatric composite scores on the ASI in patients with rapid-cycling bipolar I disorder than in those with rapid-cycling bipolar II disorder, the other clinical variables were similar between the 2 groups.
Gao
Keming
K
Department of Psychiatry, Bipolar Disorder Research Center at the Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA. keming.gao@uhhospitals.org
Verduin
Marcia L
ML
Kemp
David E
DE
Tolliver
Bryan K
BK
Ganocy
Stephen J
SJ
Elhaj
Omar
O
Bilali
Sarah
S
Brady
Kathleen T
KT
Findling
Robert L
RL
Calabrese
Joseph R
JR
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology; D010507:Periodicity; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires