title: Further Evidence for Smoking and Substance Use Disorders in Youth With Bipolar Disorder and Comorbid Conduct Disorder.
abstract: OBJECTIVE
  Bipolar disorder (BPD) is a highly morbid disorder increasingly recognized in adolescents. The aim of this study was to examine the relative risk for substance use disorders (SUDs; alcohol or drug abuse or dependence) and cigarette smoking in adolescents with BPD.
  
  
  METHODS
  We evaluated the relative risk for SUDs and cigarette smoking in a case-controlled, 5-year prospective follow-up of adolescents with (n = 105, mean ± SD baseline age = 13.6 ± 2.5 years) and without ("controls"; n = 98, baseline age = 13.7 ± 2.1 years) BPD. Seventy-three percent of subjects were retained at follow-up (BPD: n = 68; controls: n = 81; 73% reascertainment). Our main outcomes were assessed by blinded structured interviews for DSM-IV criteria.
  
  
  RESULTS
  Maturing adolescents with BPD, compared to controls, were more likely to endorse higher rates of SUD (49% vs 26%; hazard ratio [HR] = 2.0; 95% confidence interval (CI), 1.1-3.6; P = .02) and cigarette smoking (49% vs 17%; HR = 2.9; 95% CI, 1.4-6.1; P = .004), as well as earlier onset of SUD (14.9 ± 2.6 [SD] years vs 16.5 ± 1.6 [SD] years; t = 2.6; P = .01). Subjects with conduct disorder (CD) were more likely to have SUD and nicotine dependence than subjects with BPD alone or controls (all P values < .05). When we added conduct disorder to the model with socioeconomic status and parental SUD, all associations lost significance (all P values > .05). Subjects with the persistence of a BPD diagnosis were also more likely to endorse cigarette smoking and SUD in comparison to those who lost a BPD diagnosis or controls at follow-up.
  
  
  CONCLUSIONS
  The results provide further evidence that adolescents with BPD, particularly those with comorbid CD, are significantly more likely to endorse cigarette smoking and SUDs when compared to their non-mood disordered peers. These findings indicate that youth with BPD should be carefully monitored for comorbid CD and the development of cigarette smoking and SUDs.
authors: Pediatric Psychopharmacology, Massachusetts General Hospital, 55 Fruit St, YAW 6A, Boston, MA 02114. twilens@partners.org.|Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
authors: Timothy E
authors: TE
authors: Wilens
authors: Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
authors: Joseph
authors: J
authors: Biederman
authors: Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: MaryKate
authors: M
authors: Martelon
authors: Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Courtney
authors: C
authors: Zulauf
authors: Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Jesse P
authors: JP
authors: Anderson
authors: Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Nicholas W
authors: NW
authors: Carrellas
authors: Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Amy
authors: A
authors: Yule
authors: Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Janet
authors: J
authors: Wozniak
authors: Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Ronna
authors: R
authors: Fried
authors: Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, USA.
authors: Stephen V
authors: SV
authors: Faraone
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology; D016022:Case-Control Studies; D015897:Comorbidity; D019955:Conduct Disorder / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D012016:Reference Values; D012306:Risk; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult