罹患雙極性躁鬱症年輕病患物質濫用風險極高


  July 2, 2008 — 一項針對罹患雙極性躁鬱症年輕病患進行的病例控制研究結果發現,相較於控制組(4%),這些病患(31%)物質濫用(藥物或是酒精濫用或依賴性)的風險顯著較高。
  
  這些發現來自於一項進行中、縱向、以家庭為主的研究,針對罹患雙極性躁鬱症的青少年病患,發表於6月1日的藥物與酒精依賴性期刊。
  
  【躁鬱症與物質濫用風險相關 而非違規行為異常】
  主要試驗作者,波士頓麻州綜合醫院的Timothy E. Wilens醫師在電子郵件中向Medscape神經學表示,這是第一篇報導雙極性躁鬱症與物質濫用之間關聯的研究報告。他附帶表示,目前這項研究發現重新驗證了之前較小型或設計較不嚴謹的初期研究,同時突顯了雙極性躁鬱症提升了發生物質濫用的風險,且是雙極性異常而非違規行為異常(青少年犯錯行為)與這個風險有關。
  
  他繼續說道,在這項研究中,雙極性異常發生物質濫用的風險,是文獻中曾報導最高的,且與違規行為異常的風險相當;他指出,這項研究再一次顯示,青少年雙極性異常的發生,對於物質濫用的開始有最不良的影響。
  
  這對於臨床執業者的應用是很大的,他表示,所有罹患雙極性異常的病患都需要被教育有關於物質濫用的風險,相反的,所有罹患情感不穩定且物質濫用的青少年,都應該接受雙極性異常的篩檢。
  
  他附帶表示,未來的研究可能發現介入點,讓執業者可以降低雙極性異常對於藥物與酒精濫用的影響;一項小型、早期、控制組研究(Geller等人發表在J Am Acad Child Adoles Psych. 1997; 36: 1168-1176)顯示,如果一位罹患雙極性異常與物質濫用的病患,接受雙極性異常的治療,物質濫用的風險與其功能可顯著改善。
  
  【大型的介入】
  該團隊寫道,據估計,約有20%因為精神疾病接受治療的兒童與青少年有雙極性異常的問題;少數研究顯示青少年的犯錯行為可能是物質濫用異常的一個重大危險因子,但是試驗限制隱藏了對這些發現的解釋。
  
  該團隊要在案例控制研究中重新檢驗雙極性異常與青少年物質濫用的關係,他們假設雙極性異常與物質濫用之間的關係,是獨立於注意力缺損/過動異常(ADHD)、違規行為與多重焦慮異常等精神疾病之外。
  
  目前這項研究是根據一項進行中之青少年雙極性異常研究的試驗前評估。
  
  研究者檢驗105位罹患雙極性異常的受試者(平均年齡為13.6±2.5歲,其中70%是男性的)以及98位控制組受試者(平均年齡為13.7±2.1歲,其中60%是男性的);所有受試者都是從社區收納而來。
  
  雙極性異常或是其他精神異常的診斷,是根據精神疾病診斷與統計手冊第四版結構性訪談;物質濫用異常資訊則是根據與小孩及雙親的深度訪談。
  
  【研究發現支持針對青少年篩檢的重要性】
  相較於控制組,雙極性異常病患在物質濫用、藥物濫用與酒精濫用、藥物依賴性與吸菸的發生率都顯著較高。
  
  罹患與未罹患雙極性易長青少年物質濫用風險

物質濫用

罹患雙極性異常年輕病患發生率 (%)

控制組年輕受試者發生率 (%)

風險比值 (95% CI)

P

任何物質濫用的終生風險

34

4

8.68 (3.02 – 25.0)

< .001

酒精濫用

23

3

7.66 (2.20 – 26.7)

.001

藥物濫用

22

1

18.5 (2.46 – 139.1)

.005

藥物依賴性

14

1

12.1 (1.54 – 95.5)

.02

吸菸

22

4

12.3 (2.83 – 53.69)

< .001

*校正年齡與ADHD、違規異常與多重焦慮異常
  
  14%罹患雙極性異常受試者,同時有藥物與酒精濫用異常,但控制組受試者則沒有這樣的問題(P<.001)。
  
  Wilens醫師總結指出,這些研究結果顯示,罹患雙極性異常的年輕病患需要仔細地接受物質濫用篩檢,且已知濫用藥物與酒精的青少年,特別是那些狂歡濫用,都應該接受雙極性異常的篩檢。
  
  Wilens醫師接受國家物質濫用機構以及下列藥品公司的研究經費、演講費或是擔任顧問的費用,這些公司包括Abbott實驗室、Ortho-McNeil、Eli Lilly、Norvatis與Shire實驗室。其他作者的資金上的關係條列於該篇文章中。
  

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)
*Adjusted for age and independent of attention deficit/hyperactivity disorder (ADHD), conduct disorder, and multiple anxiety disorder.

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

    
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