Bipolar affective disorder and substance abuse.

Area of Science:

• Psychiatry
• Neuroscience
• Clinical Psychology

Background:

• Substance abuse disorders and psychiatric disorders frequently co-occur.
• Substance abuse, particularly cocaine and alcohol, is more prevalent in patients with bipolar disorder than in the general population.
• Bipolar disorder is the most common Axis I disorder associated with substance abuse.

Purpose of the Study:

• To review the co-occurrence of bipolar disorder and substance abuse.
• To highlight diagnostic challenges and treatment considerations for this dual-diagnosis population.
• To identify gaps in research regarding clinical features and therapeutic strategies.

Main Methods:

• Review of epidemiologic data and treatment-seeking populations.
• Analysis of National Institute of Mental Health Epidemiologic Catchment Area data.
• Synthesis of evidence from clinical samples of patients with co-occurring disorders.

Main Results:

• Co-occurrence of bipolar disorder and substance abuse is significantly higher than expected by chance.
• Substance abuse in bipolar patients is linked to a more severe illness course.
• Diagnosing bipolar disorder is challenging due to substance-induced psychiatric symptoms.

Conclusions:

• Effective treatment strategies for co-occurring bipolar disorder and substance abuse require further investigation.
• Anticonvulsant, antikindling agents show theoretical promise but lack controlled study data.
• Comparative studies of mood stabilizers (e.g., lithium) and antikindling agents (e.g., valproate, carbamazepine) are warranted.