Alcohol use disorders are associated with increased affective lability in bipolar disorder.
Affective dysregulation is a core feature of bipolar disorder (BD), and inter-episodic affect lability is associated with more severe outcomes including comorbidity. Rates of daily tobacco smoking and substance use disorders in BD are high. Knowledge regarding relationships between affective lability and abuse of the most commonly used substances such as tobacco, alcohol and cannabis in BD is limited.



We investigated whether dimensions of inter-episodic affective lability as measured with the Affective Lability Scale - short form (ALS-SF) were associated with lifetime daily tobacco use or alcohol (AUD) or cannabis use disorders (CUD) in a sample of 372 French and Norwegian patients with BD I and II.



ALS-SF total score and all sub-dimensions (anxiety-depression, depression-elation and anger) were significantly associated with AUD, while only the depression-elation sub-dimension was associated with CUD, after controlling for possible confounders such as gender, age at interview, age at illness onset, BD subtype, duration of illness and other substance use disorders. Daily tobacco smoking was not significantly associated with affective lability.



Data for recent substance use or psychiatric comorbidities such as personality or hyperkinetic disorders were not available, and could have mediated the relationships.



AUD is associated with several dimensions of inter-episodic affective lability in BD, while CUD is associated with increased oscillations between depression and elation only. Increased affective lability may partly explain the increased illness severity of patients with BD and AUD or CUD. Affective lability should be treated in order to prevent these comorbidities.
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: t.v.lagerberg@medisin.uio.no.
Trine Vik
TV
Lagerberg
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Specialized Inpatient Treatment, Division of Mental Health Services, Akershus University Hospital, Norway.
Sofie Ragnhild
SR
Aminoff
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Monica
M
Aas
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Thomas
T
Bjella
AP-HP, Hôpital H. Mondor - A. Chenevier, DHU Pepsy, Pôle de Psychiatry, Créteil 94000, France; Inserm, U955, Créteil 94000, France; Institut Pasteur, Unité Perception et Mémoire, F-75015 Paris, France; ENBREC, European Network of Bipolar Research Expert Centres, Paris, France.
Chantal
C
Henry
AP-HP, Hôpital H. Mondor - A. Chenevier, DHU Pepsy, Pôle de Psychiatry, Créteil 94000, France; Inserm, U955, Créteil 94000, France; ENBREC, European Network of Bipolar Research Expert Centres, Paris, France; Fondation FondaMental, Créteil, France.
Marion
M
Leboyer
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Oslo University Hospital, Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo, Norway.
Geir
G
Pedersen
ENBREC, European Network of Bipolar Research Expert Centres, Paris, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris Cedex 10, France; Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France.
Frank
F
Bellivier
AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris Cedex 10, France; Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France.
Romain
R
Icick
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Fondation FondaMental, Créteil, France.
Ole A
OA
Andreassen
ENBREC, European Network of Bipolar Research Expert Centres, Paris, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris Cedex 10, France; Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France.
Bruno
B
Etain
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Ingrid
I
Melle
D000328:Adult; D000339:Affect; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D000073869:Tobacco Smoking; D055815:Young Adult
Affective lability; Alcohol use disorders; Bipolar disorder; Cannabis use disorders; Tobacco smoking