Predictors of clinical trial dropout in individuals with co-occurring bipolar disorder and alcohol dependence

Abstract

Background Individuals with co-occurring bipolar disorder and alcohol dependence have particularly low rates of retention in clinical trials. Past research has identified a variety of factors associated with dropout in this population, but few have been replicated. The present study investigated the ability of several baseline variables, to predict clinical trial dropout in a sample of individuals with co-morbid bipolar and alcohol use disorders. Methods Demographics, psychiatric diagnoses, recent alcohol use, mood pathology, and risk taking behavior (measured with the Balloon Analogue Risk Task) were evaluated as predictors of dropout from a randomized clinical trial of acamprosate for individuals with co-morbid bipolar and alcohol use disorders (n = 30) using stepwise logistic regression. Results Risk taking behavior was the only significant predictor of dropout in the present study (OR = 1.44, p = 0.03), opiate dependence marginally predicted dropout as well (OR = 13.46, p = 0.08). A model consisting of these predictors, as well as acamprosate group status (p = 0.13), provided excellent prediction of dropout (i.e., area under the ROC curve = 0.94; R2 = 0.53). Conclusions Given the robust relationship between risk taking and dropout in the present study, the Balloon Analogue Risk Task may represent a valuable tool for researchers to predict who will drop out of clinical trials for comorbid bipolar and substance use disorders.

Crianças e adolescentes usuários de substâncias no serviço de emergência psiquiátrica

“…Several studies have found a relationship between substance use and a gap in education or dropping out of school. (9,11,16,17) Among participants in our study, 74.6% were Catholic and 18.5% were Protestants. It is important to mention that in Brazil, identification of a specific religion does not necessarily mean that the person regularly practices the religion.…”

Review paper. Does genius border on insanity? Part I: A relationship between creativity and the presence of psychopathological symptoms in bipolar disorder

“…It is noted that to a large extent, in addition to creativity, artists are characterized by nonconformity, complexity of interests. They attribute great importance to intuition and independence [31]. This issue is developed by Sass (2001), by combining the correlation between bipolar disorder and creativity of artists with some specific personality predispositions such as emotionality, applying great importance to prevailing social hierarchy ("superiority felt in mania, sense of rejection in depression") [ 28].…”

“…Nancy Andreasen (2008) notes that excessive sensitivity to surrounding stimuli might also lead artists to seek solutions to mitigate the severe mood swings [32]. This could explain the tendency of artists to alcohol abuse (Prisciandaro et al, 2011) [33], as well as accidental often made suicide attempts (Ludwig, 1997) [34].…”

“…One can only presume that the experiences of these periods were the inspiration for the creation of new works. Struggles with relapse in 1941 led the outstanding artist to suicide [31]. Research works of Andreasen (2008) relate a period of recovery from depression with the utmost ingenuity of artists suffering from bipolar disorder.…”

“…Zauważa się, że w dużej mierze, oprócz kreatywności, artyści cechują się nonkonformizmem, złożonością zainteresowań. Duże znaczenie przypisują intuicji i niezależności [31]. Zagadnienie to w swoich pracach rozwija Sass (2001), łącząc korelację między chorobą afektywną dwubiegunową i kreatywnością u artystów z pewnymi konkretnymi predyspozycjami osobowościowymi takimi jak uczuciowość, przykładanie dużego znaczenia panującej hierarchii społecznej ("wyższość odczuwana w manii, poczucie odrzucenia w depresji") [28].…”