title: 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.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. keming.gao@uhhospitals.org
authors.forename: K
authors.initials: K
authors.lastname: Gao
authors.forename: D E
authors.initials: DE
authors.lastname: Kemp
authors.forename: C
authors.initials: C
authors.lastname: Conroy
authors.forename: S J
authors.initials: SJ
authors.lastname: Ganocy
authors.forename: R L
authors.initials: RL
authors.lastname: Findling
authors.forename: J R
authors.initials: JR
authors.lastname: Calabrese
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy; D001714:Bipolar Disorder / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000188:drug therapy*
chemical_list: D014151:Anti-Anxiety Agents; D018692:Antimanic Agents
references.citation: J Clin Psychiatry. 2007 Nov;68(11):1785-92
references.pmid: 18052573
references.citation: Bipolar Disord. 2008 Feb;10(1 Pt 2):163-78
references.pmid: 18199235
references.citation: J Affect Disord. 2001 Jul;65(2):105-15
references.pmid: 11356233
references.citation: Bipolar Disord. 2008 Feb;10(1 Pt 2):117-28
references.pmid: 18199230
references.citation: J Clin Psychiatry. 2003 Feb;64(2):161-74
references.pmid: 12633125
references.citation: Psychiatr Serv. 2001 Jan;52(1):51-5
references.pmid: 11141528
references.citation: J Clin Psychopharmacol. 2004 Oct;24(5):512-20
references.pmid: 15349007
references.citation: J Clin Psychiatry. 2003 Oct;64(10):1201-9
references.pmid: 14658969
references.citation: J Psychiatr Pract. 2006 Mar;12(2):124-7
references.pmid: 16728911
references.citation: Arch Gen Psychiatry. 2007 May;64(5):543-52
references.pmid: 17485606
references.citation: Compr Psychiatry. 1993 Sep-Oct;34(5):303-7
references.pmid: 8306639
references.citation: J Clin Psychiatry. 2008 Jul;69(7):1057-63
references.pmid: 18588360
references.citation: J Affect Disord. 1994 Aug;31(4):281-94
references.pmid: 7989643
references.citation: J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57
references.pmid: 9881538
references.citation: J Clin Psychiatry. 2008 Nov;69(11):1751-7
references.pmid: 18945397
references.citation: Bipolar Disord. 2009 May;11(3):225-55
references.pmid: 19419382
references.citation: Int J Neuropsychopharmacol. 2005 Jun;8(2):281-92
references.pmid: 15737249
references.citation: J Affect Disord. 2002 Feb;68(1):33-9
references.pmid: 11869780
references.citation: J Affect Disord. 1999 Jan-Mar;52(1-3):135-44
references.pmid: 10357026
references.citation: J Affect Disord. 2007 Aug;101(1-3):211-7
references.pmid: 17254638
references.citation: Psychol Med. 1997 Sep;27(5):1079-89
references.pmid: 9300513
references.citation: J Clin Psychiatry. 2008 May;69(5):749-58
references.pmid: 18363423
references.citation: Bipolar Disord. 2008 Mar;10(2):238-44
references.pmid: 18271902
references.citation: Am J Psychiatry. 2004 Dec;161(12):2222-9
references.pmid: 15569893
references.citation: J Clin Psychiatry. 2009 Jan;70(1):113-21
references.pmid: 19192457
references.citation: J Clin Psychiatry. 2007 Jan;68(1):102-10
references.pmid: 17284137
references.citation: JAMA. 1990 Nov 21;264(19):2511-8
references.pmid: 2232018
references.citation: J Clin Psychiatry. 2005 Nov;66(11):1432-40
references.pmid: 16420081
references.citation: Psychiatr Serv. 2005 Dec;56(12):1529-33
references.pmid: 16339614
references.citation: Bipolar Disord. 2008 Feb;10(1 Pt 2):144-52
references.pmid: 18199233
references.citation: Arch Gen Psychiatry. 1981 Apr;38(4):400-5
references.pmid: 7212970
references.citation: Bipolar Disord. 2006 Dec;8(6):665-76
references.pmid: 17156153
references.citation: Psychiatry Res. 1986 Dec;19(4):285-96
references.pmid: 3809326
references.citation: Am J Psychiatry. 2005 Nov;162(11):2152-61
references.pmid: 16263857
references.citation: Am J Psychiatry. 2002 Apr;159(4 Suppl):1-50
references.pmid: 11958165
references.citation: J Clin Psychiatry. 2001;62 Suppl 14:34-41
references.pmid: 11469674
references.citation: J Clin Psychiatry. 2000 Oct;61(10):804-8; quiz 809
references.pmid: 11078046
references.citation: J Affect Disord. 2005 Apr;85(3):301-15
references.pmid: 15780700
references.citation: Psychiatr Serv. 2007 Jan;58(1):85-91
references.pmid: 17215417
references.citation: J Clin Psychiatry. 2005 Jul;66(7):870-86
references.pmid: 16013903
references.citation: J Clin Psychiatry. 2005 Oct;66(10):1205-15
references.pmid: 16259532
references.citation: J Clin Psychiatry. 2002 Dec;63(12):1129-34
references.pmid: 12523872
references.citation: Drug Alcohol Depend. 2005 Nov 1;80(2):251-7
references.pmid: 15876498
references.citation: Pharmacol Biochem Behav. 2007 Feb;86(2):395-400
references.pmid: 17188743
references.citation: Arch Gen Psychiatry. 2002 Aug;59(8):736-40
references.pmid: 12150650
references.citation: Am J Psychiatry. 1999 Jul;156(7):1094-6
references.pmid: 10401459
references.citation: Am J Manag Care. 2005 Oct;11(9 Suppl):S271-4
references.pmid: 16232009
references.citation: J Affect Disord. 2008 Sep;110(1-2):167-73
references.pmid: 18234350
references.citation: Am J Psychiatry. 2001 Mar;158(3):420-6
references.pmid: 11229983
references.citation: J Affect Disord. 2004 Nov 1;82(3):373-83
references.pmid: 15555688
references.citation: J Clin Psychiatry. 2006 Apr;67(4):584-93
references.pmid: 16669723