Prognostic Factors of 2-year Outcomes of Patients with Comorbid Bipolar Disorder or Depression with Alcohol Dependence: Importance of Early Abstinence

Abstract

-Aims: To investigate the prognostic factors that determine 2-year outcomes in a group of alcohol-dependent patients with depression or bipolar disorder who were treated in an intensive 4-week inpatient programme. Methods: This was a longitudinal study of an inpatient treatment cohort of dual affective disorder and alcohol-dependent patients, in Dublin, Ireland. Measurements included baseline demographics with follow-up measurements at discharge, 3 months, 6 months and 2 years after treatment, including alcohol consumption, depression, mania/elation, anxiety, craving, drug use and sample blood tests. Factor and regression analysis of multiple variables was carried out to predict outcomes. Results: A total of 189 participants with alcohol dependence and comorbid depression (n = 101) or bipolar disorder (n = 88) were followed over 2 years after discharge from treatment. Retention rate was 76% over 2 years. Early abstinence (at 6 months) predicted better abstinence overall at 2 years; and bipolar alcoholics had a better outcome in drinks per drinking day than depressed alcoholics at 2 years. Younger participants (age 18-30 years) did relatively worse than middle-age (30-50 years) and older (51 + years) participants in measures of abstinence and number of drinks per drinking day at 2 years; and females did better than males in number of drinks per drinking day at 2 years. Conclusion: Dual diagnosis of alcohol dependence and depression or bipolar disorder may be treated together with intensive intervention and follow-up, and various prognostic factors including early abstinence emerge over time that influence outcomes over 2 years.

Who receives treatment for alcohol use disorders in the European Union? A cross-sectional representative study in primary and specialized health care

“…Early treatment is essential for prevention of alcohol liver disease including liver cirrhosis as well as for effective treatment of comorbid affective disorders (for example see [13,14]). However, the data seem to indicate that most treatment at the PC and SC level in Europe is delivered to people with a high level of existing comorbidity.…”

Revisión de la eficacia de los tratamientos para el trastorno bipolar en comorbilidad con el abuso de sustancias

“…Por tanto, parece de especial interés el desarrollo de nuevas investigaciones que profundicen en la eficacia de diferentes abordajes que traten el trastorno psiquiátrico al mismo tiempo que tratan de promover la abstinencia temprana y la desintoxicación de las drogas de consumo 13 . En este sentido, será también conveniente la detección previa y la prevención atendiendo a factores de riesgo sociodemográficos, como el sexo masculino, la juventud, el bajo nivel educativo, el diagnóstico previo de trastorno del ánimo o una historia parental de TUS 61---63 , así como a otros más recientemente planteados: la historia de abuso físico o sexual 64 .…”

“…Algunos estudios muestran cómo el consumo de alcohol en estos sujetos se asocia a mayores déficits cognitivos, especialmente en memoria visual y verbal y en funcionamiento ejecutivo y habilidades de razonamiento 9,10 , mientras que el consumo de tabaco o cannabis parece asociarse a un empeoramiento de la sintomatología en el TB 11,12 . Alternativamente, varios trabajos señalan la abstinencia temprana de cualquier consumo como predictor favorable de una mejor evolución de la persona con TB 13 . En todo caso, las personas con diagnósti-cos concomitantes de TB y TUS suelen tener mayor actividad criminal y peor funcionamiento en la vida social que aquellas que solo cursan con bipolaridad, llegando a equipararse a las personas con un diagnóstico de esquizofrenia sin TUS 14,15 .…”

The impact of mood symptomatology on pattern of substance use among homeless

“…Foremost, they are commonly co-morbid (Merikangas et al, 2008) with the bipolar spectrum being associated with cocaine (Cocores et al, 1987;Maremmani et al, 2008;Nunes et al, 1989;Perugi et al, 2012;Post and Kalivas, 2013;Weiss and Mirin, 1986), cannabis (Arias et al, 2013;Ashton et al, 2005;Do and Mezuk, 2013;Maremmani et al, 2000bMaremmani et al, , 2004Maremmani et al, , 2006a, benzodiazepines (Brunette et al, 2003;Lin et al, 2011;Perugi et al, 2002), alcohol (Bernardt and Murray, 1986;Brousse et al, 2008;Chengappa et al, 2000;Farren et al, 2013;Fletcher et al, 2013;Freed, 1969;Nery et al, 2010;Weiss and Mirin, 1989) and heroin (Maremmani, 2013;Maremmani et al, 2014a). Indeed, because bipolar spectrum disorders and addiction are so often comorbid, each operates as reciprocal risk factors and should be viewed from a unified perspective (Camacho and Akiskal, 2005;Maremmani et al, 2006b).…”