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July 2, 2008 — 一项针对罹患双极性躁郁症年轻病患进行的病例控制研究结果发现，相较于控制组（4%），这些病患（31%）物质滥用（药物或是酒精滥用或依赖性）的风险显著较高。
这些发现来自于一项进行中、纵向、以家庭为主的研究，针对罹患双极性躁郁症的青少年病患，发表于6月1日的药物与酒精依赖性期刊。
【躁郁症与物质滥用风险相关 而非违规行为异常】
主要试验作者，波士顿麻州综合医院的Timothy E. Wilens医师在电子邮件中向Medscape神经学表示，这是第一篇报导双极性躁郁症与物质滥用之间关联的研究报告。他附带表示，目前这项研究发现重新验证了之前较小型或设计较不严谨的初期研究，同时突显了双极性躁郁症提升了发生物质滥用的风险，且是双极性异常而非违规行为异常（青少年犯错行为）与这个风险有关。
他继续说道，在这项研究中，双极性异常发生物质滥用的风险，是文献中曾报导最高的，且与违规行为异常的风险相当；他指出，这项研究再一次显示，青少年双极性异常的发生，对于物质滥用的开始有最不良的影响。
这对于临床执业者的应用是很大的，他表示，所有罹患双极性异常的病患都需要被教育有关于物质滥用的风险，相反的，所有罹患情感不稳定且物质滥用的青少年，都应该接受双极性异常的筛检。
他附带表示，未来的研究可能发现介入点，让执业者可以降低双极性异常对于药物与酒精滥用的影响；一项小型、早期、控制组研究（Geller等人发表在J Am Acad Child Adoles Psych. 1997; 36: 1168-1176）显示，如果一位罹患双极性异常与物质滥用的病患，接受双极性异常的治疗，物质滥用的风险与其功能可显著改善。
【大型的介入】
该团队写道，据估计，约有20%因为精神疾病接受治疗的儿童与青少年有双极性异常的问题；少数研究显示青少年的犯错行为可能是物质滥用异常的一个重大危险因子，但是试验限制隐藏了对这些发现的解释。
该团队要在案例控制研究中重新检验双极性异常与青少年物质滥用的关系，他们假设双极性异常与物质滥用之间的关系，是独立于注意力缺损/过动异常（ADHD）、违规行为与多重焦虑异常等精神疾病之外。
目前这项研究是根据一项进行中之青少年双极性异常研究的试验前评估。
研究者检验105位罹患双极性异常的受试者（平均年龄为13.6±2.5岁，其中70%是男性的）以及98位控制组受试者（平均年龄为13.7±2.1岁，其中60%是男性的）；所有受试者都是从社区收纳而来。
双极性异常或是其他精神异常的诊断，是根据精神疾病诊断与统计手册第四版结构性访谈；物质滥用异常资讯则是根据与小孩及双亲的深度访谈。
【研究发现支持针对青少年筛检的重要性】
相较于控制组，双极性异常病患在物质滥用、药物滥用与酒精滥用、药物依赖性与吸烟的发生率都显著较高。
罹患与未罹患双极性易长青少年物质滥用风险
|
物质滥用 |
罹患双极性异常年轻病患发生率 (%)
|
控制组年轻受试者发生率 (%)
|
风险比值 (95% CI)
|
P
|
|
任何物质滥用的终生风险 |
34
|
4
|
8.68 (3.02 – 25.0)
|
< .001
|
|
酒精滥用 |
23
|
3
|
7.66 (2.20 – 26.7)
|
.001
|
|
药物滥用 |
22
|
1
|
18.5 (2.46 – 139.1)
|
.005
|
|
药物依赖性 |
14
|
1
|
12.1 (1.54 – 95.5)
|
.02
|
|
吸烟 |
22
|
4
|
12.3 (2.83 – 53.69)
|
< .001
|
Huge Risk of Substance Abuse Found Among Teens with Bipolar Disorder
By Marlene Busko
Medscape Medical News
July 2, 2008 — A case-control study in youth with bipolar disorder with a mean age of 14 years found a significantly higher risk of substance-use disorder (drug or alcohol abuse or dependence) (31%) compared with controls (4%).
These findings, from an ongoing, longitudinal family-based study of adolescents with bipolar disorder, are published in the June 1 issue of Drug and Alcohol Dependence.
Bipolar Disorder Not Conduct Disorder Linked to Risk
"We were the first to report on the association of bipolar disorder and substance abuse," lead study author Timothy E. Wilens, MD, from Massachusetts General Hospital and Harvard Medical School, in Boston, Massachusetts, told Medscape Psychiatry in an email. The current findings replicate a smaller and less controlled initial study and "highlight the massive risk that bipolar disorder bestows upon the development of substance abuse and that it is bipolar disorder and not conduct disorder (juvenile delinquency) that is associated with that risk," he added.
In this study, the risk from bipolar disorder for substance abuse is among the highest risk ever described in the literature and is equal to the risk from conduct disorder, he continued. The study "shows that yet again, the onset of bipolarity in adolescence is particularly malignant for the onset of substance abuse," he said.
The implications for clinical practitioners are huge, he continued. All patients with bipolar disorder need to be educated about the risk for substance abuse, and conversely, all substance-abusing youth with mood instability need to be carefully screened for bipolar disorder, he said.
Future studies might discover intervention points where practitioners could reduce the influence of bipolar disorder on drug and alcohol abuse, he added. One small, older, controlled study (Geller et al. J Am Acad Child Adoles Psych. 1997;36:1168-1176) showed that if a youth has bipolar disorder and substance abuse and the bipolar disorder is treated, the risk for substance abuse and patient functioning are dramatically improved, he added.
Large Investigation
It has been estimated that 20% of children and adolescents treated for psychiatric problems have bipolar disorder, the group writes. A few studies suggest that juvenile-onset bipolar disorder may be a major risk factor for substance-abuse disorder, but study limitations hinder the interpretation of these findings.
The group aimed to reexamine the association between bipolar disorder and substance abuse in adolescents in a case-controlled study. They hypothesized that the association between bipolar disorder and substance-abuse disorder would be independent of psychiatric comorbidity with attention deficit/hyperactivity disorder (ADHD), conduct disorder, and multiple anxiety disorder.
The current study is based on baseline assessments from an ongoing study of bipolar disorder in adolescents.
The investigators examined 105 subjects with bipolar disorder (mean age 13.6 ± 2.5 years, 70% male) and 98 controls (mean age 13.7 ± 2.1 years, 60% male); all participants were recruited form the community.
Diagnosis of bipolar disorder and other psychiatric disorders were made using Diagnostic and Statistical Manual of Mental Disorders, 4th ed structured interviews. Substance-abuse–disorder information was based on in-depth interviews with the child and with the parents.
Findings Support Importance of Screening Teens
The incidences of any substance-use disorder, alcohol abuse, drug abuse, drug dependence, and cigarette smoking were each significantly higher in the participants with bipolar disorder compared with the control subjects.
Risk of Substance Use Among Youth With vs Without Bipolar Disorder*
| Substance Use | Incidence in Bipolar Youth (%) |
Incidence in Control Youth (%) |
Risk Ratio (95% CI) | P |
| Lifetime prevalence of any substance use disorder | 34 | 4 | 8.68 (3.02?–?25.0) | |
| Alcohol abuse | 23 | 3 | 7.66 (2.20?–?26.7) | .001 |
| Drug abuse | 22 | 1 | 18.5 (2.46?–?139.1) | .005 |
| Drug dependence | 14 | 1 | 12.1 (1.54?–?95.5) | .02 |
| Cigarette smoking | 22 | 4 | 12.3 (2.83?–?53.69) |
No control subjects but 14% of subjects with bipolar disorder had both drug- and alcohol-use disorder (P < .001).
This work indicates that young people with bipolar disorder need to be carefully screened for substance abuse, and adolescents known to abuse drugs and alcohol — especially those who binge use — should also be assessed for bipolar disorder, Dr. Wilens summarized.
Dr. Wilens acknowledges receiving research support from, being a speaker for, or being on the advisory board of the National Institute on Drug Abuse and the following pharmaceutical companies: Abbott Laboratories, Ortho-McNeil, Eli Lilly, Novartis Pharmaceuticals, and Shire Laboratories. The financial disclosures of the other authors are listed in the paper.
Drug Alcohol Depend.2008;95:188-198. Abstract