title: Prevalence and impact of comorbid alcohol use disorder in bipolar disorder: A prospective follow-up study.
abstract: OBJECTIVE
  Alcohol use disorder may very well increase the likelihood of affective episodes in bipolar disorder, but prospective data on survival are inconsistent.
  
  
  METHODS
  The authors examined the prevalence of alcohol use disorders and their impact on the risk of relapse. A total of 284 consecutively admitted International Classification of Diseases-10 bipolar I (n = 161) and II (n = 123) patients were followed up naturalistically over a period of 4 years.
  
  
  RESULTS
  The prevalence of alcohol use disorders was higher in bipolar II disorder than in bipolar I disorder (26.8% vs 14.9%; χ(2) = 5.46, p = 0.019), with a global prevalence of alcohol use disorders of 20.1% in the whole sample. A total of 8.7% of bipolar I patients suffered from alcohol abuse and 6.2% from alcohol dependency, whereas 13% bipolar II patients had alcohol abuse and 13.8% alcohol dependency. Male bipolar subjects had a higher prevalence of alcohol use disorders than female patients (38.3% vs 12.8%; χ(2) = 21.84, p-value < 0.001). The presence of alcohol use disorders was associated with an increased risk of depressive relapse in bipolar I patients (Cox regression analysis hazard ratio = 2.7, p = 0.005). The increased risk was not modulated by medication.
  
  
  CONCLUSIONS
  Our data underline the negative long-term impact of alcohol use disorders on bipolar disorder with more depressive bipolar I episodes and the importance of its detection and treatment.
authors.affiliation: Bipolar Center Wiener Neustadt, Wiener Neustadt, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Simhandl
authors.affiliation: FIDMAG Research Foundation Germanes Hospitaláries, CIBERSAM, Barcelona, Spain Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Radua
authors.affiliation: Bipolar Center Wiener Neustadt, Wiener Neustadt, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: König
authors.affiliation: FIDMAG Research Foundation Germanes Hospitaláries, CIBERSAM, Barcelona, Spain Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK benedikt.amann@gmail.com.
authors.forename: Benedikt L
authors.initials: BL
authors.lastname: Amann
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents
keywords: Bipolar disorder; affective disorders; alcohol; comorbidity; relapse