title: Reliability of self-reported tobacco use in bipolar disorder: an exploratory study of euthymic patients visiting a tertiary care hospital in India.
abstract: BACKGROUND
  Unlike schizophrenia, only a little attention has been paid to tobacco dependence in patients with bipolar disorder despite a similarly high prevalence and predisposition to health risks. The euthymic phase is especially suitable for tobacco screening by the treating psychiatrist. However, the validity of self-report for tobacco use in this patient population remains undetermined.
  
  
  OBJECTIVE
  The current study aims to assess the validity of self-reported tobacco use in euthymic bipolar disorder.
  
  
  METHODS
  The psychiatric out-patients with DSM-IV TR diagnosis of bipolar type-I in remission who were males, > or =18 years, and euthymic as established by current scores of <7 on HAM-D and <4 on YMRS. Patients were specifically asked for the recent use of tobacco in any form. Ten ml urine sample was obtained after informed consent and subjected to a quantitative cotinine estimation by direct enzyme-linked immunosorbent assay.
  
  
  RESULTS
  A total of 100 patients were screened, of which 79 were finally included. The self-report for recent tobacco use showed only a moderate concordance with urinary cotinine (k = 0.518) and cotinine-creatinine ratio (k = 0.492). Over 15% patients had denied the use of tobacco, but tested positive on urinary cotinine assessment. The sensitivity of self-report was 73.3% compared to urinary cotinine. The denial among users was 26.7% and denial among those with negative self-report was 30.8%.
  
  
  CONCLUSIONS
  Mental health professionals should be vigilant for detection of tobacco dependence among remitted bipolar patients, who may not be so forthcoming about their tobacco use.
authors: All India Institute of Medical Sciences, New Delhi.
authors: Raman Deep
authors: RD
authors: Pattanayak
authors: Raka
authors: R
authors: Jain
authors: Rajesh
authors: R
authors: Sagar
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D003367:Cotinine / Q000652:urine*; D006801:Humans; D007194:India; D008297:Male; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D057566:Self Report / Q000592:standards*; D014029:Tobacco Use Disorder / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D003367:Cotinine