title: Cannabis use disorder is associated with greater illness severity in tobacco smoking patients with bipolar disorder.
abstract: OBJECTIVE
  Cannabis use disorders (CUD) may influence the course of bipolar disorder (BD), but key confounding factors such as tobacco smoking have not been adequately addressed. This study examined whether CUD was associated with a more severe illness course in tobacco smoking BD patients.
  
  
  METHODS
  A sample of French and Norwegian tobacco smoking patients with BD I and II (N=642) was investigated. DSM-IV diagnoses and other characteristics were obtained through personal interviews using structured questionnaires. The association between CUD and illness course was assessed in regression analyses.
  
  
  RESULTS
  In bivariate analyses, CUD was associated with earlier BD onset, higher frequency of manic (in BD I) and depressive episodes and hospitalizations per illness year, and a higher occurrence of psychotic episodes. After controlling for potential confounders, the relationships with earlier BD onset (B=-5.60 95% CI=-7.65 to -3.64), and increased rates of manic episodes (OR=1.93, 95% CI: 1.15 to 3.23) and hospitalizations (OR=2.93, 95% CI: 1.85 to 4.64) remained statistically significant.
  
  
  CONCLUSIONS
  Despite the multivariate approach, differences between the two samples may lead to spurious findings related to hidden confounders. Substance use and mood episode information was collected retrospectively, and potential birth cohort effects could not be controlled for.
  
  
  CONCLUSIONS
  Studies have found associations between tobacco smoking and poorer outcomes in BD. In this study on tobacco smoking BD patients we report an association between CUD and illness severity, suggesting that CUD exacerbates the disease evolution independently of tobacco smoking. Specific treatment and prevention programs addressing CUD in BD patients are warranted.
authors.affiliation: NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway. Electronic address: t.v.lagerberg@medisin.uio.no.
authors.forename: T V
authors.initials: TV
authors.lastname: Lagerberg
authors.affiliation: Inserm, U1144, Paris F-7 5006, France; Université Paris Diderot, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris F-75010, France; FondaMental Foundation, Creteil F-94000, France.
authors.forename: R
authors.initials: R
authors.lastname: Icick
authors.affiliation: NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway.
authors.forename: O A
authors.initials: OA
authors.lastname: Andreassen
authors.affiliation: NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway.
authors.forename: P A
authors.initials: PA
authors.lastname: Ringen
authors.affiliation: FondaMental Foundation, Creteil F-94000, France; Inserm, U955, Equipe Psychiatrie Génétique, Créteil 94000, France; Université Paris Est, Faculté de médecine, Créteil 94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU PePsy, Pôle de psychiatrie, Créteil 94000, France.
authors.forename: B
authors.initials: B
authors.lastname: Etain
authors.affiliation: NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Aas
authors.affiliation: FondaMental Foundation, Creteil F-94000, France; Inserm, U955, Equipe Psychiatrie Génétique, Créteil 94000, France; Université Paris Est, Faculté de médecine, Créteil 94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU PePsy, Pôle de psychiatrie, Créteil 94000, France.
authors.forename: C
authors.initials: C
authors.lastname: Henry
authors.affiliation: NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway.
authors.forename: T D
authors.initials: TD
authors.lastname: Bjella
authors.affiliation: NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway.
authors.forename: I
authors.initials: I
authors.lastname: Melle
authors.affiliation: Inserm, U1144, Paris F-7 5006, France; Université Paris Diderot, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris F-75010, France; FondaMental Foundation, Creteil F-94000, France.
authors.forename: F
authors.initials: F
authors.lastname: Bellivier
mesh_terms: D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000150:complications* / Q000523:psychology; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects* / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Bipolar disorder; Cannabis use disorder; Illness severity; Tobacco