The Prevalence and Correlates of Nicotine Use Disorder Among Bipolar Patients in a Hospital Setting, Malaysia

Abstract

Objective:The authors sought to determine the prevalence of nicotine use disorder, related demographic characteristic features, and associated correlates of nicotine use disorder among bipolar patients who attended inpatient and outpatient services in a university hospital setting in Malaysia. Methods: In this cross-sectional study conducted from March 2009 to September 2010, a total of 121 bipolar patients, whose diagnoses were based on the Mini International Neuropsychiatric Interview (bipolar version 5.0.0), were recruited. Their nicotine use disorders were assessed with the Mini International Neuropsychiatric Interview (plus version) and the Fagerström Test for Nicotine Dependence. The associated correlates of nicotine use disorder were assessed with the Addiction Severity Index-Lite-Clinical Factors version. The number of lifetime hospitalizations and the survival days (defined as the number of days between the last discharge and the most current readmission for all patients who had been readmitted to the hospital) were calculated. Results: The prevalence of nicotine use disorder among bipolar patients was 22.3% (n = 27). Male gender was the only demographic factor that was statistically associated with nicotine use disorder (p < .001). Patients with nicotine use disorder had significantly more psychiatric hospitalizations than those without nicotine use disorder after adjusting for gender, race, employment status, education level and duration of illness (p < .001). Conclusions: The rate of nicotine use disorder among bipolar patients in this study is similar to that of the general population in Malaysia but lower than that of hospitalized bipolar patients in other parts of the world. Male bipolar patients had higher risk of nicotine use disorder, which was also associated with a higher rate of prior psychiatric hospitalizations. Because there is a high prevalence of nicotine use disorder among bipolar patients, as well as potential interactions with the course of the disorder, nicotine use should be addressed in these patients. (Journal of Dual Diagnosis, 8:28-34, 2012)

Tobacco Use in Bipolar Disorder

“…Inconsistent findings on the impact of tobacco smoking on prognosis in bipolar disorder have also been recently reported in a comprehensive review on the effects of smoking on the health outcomes in bipolar disorder. 32 ) In the reviewed studies, tobacco smoking was correlated with rapid cycling, 4 , 8 , 33 ) more affective episodes, 32 , 33 ) elevated risk of psychotic episodes, 12 ) and more time spent in hospital, 20 , 30 ) in some studies but not in others. Individual differences in nicotine dependence may account for the variability of the findings between studies.…”

“…Specific associations between tobacco smoking status and symptom characteristics of the disorder have been described. 7 , 8 , 11 , 12 , 30 , 31 ) In an early study looking at the role of tobacco smoking and psychotic symptom status in bipolar disorder, Corvin et al . 12 ) examined the effect of smoking severity on a sample of 92 patients with bipolar disorder.…”

“…Other studies have reported a link between tobacco smoking and worse outcomes in both mania and depression in bipolar disorder. 7 , 8 , 10 , 30 , 31 ) In particular, a large study of 399 patients with bipolar disorder reported that a lifetime history of tobacco smoking was significantly related to earlier onset of the first depressive or manic episode, greater symptom severity, poorer functioning, a lifetime history of suicide attempt comorbid anxiety and substance abuse. 10 ) In addition, results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) have linked tobacco smoking to clinical variables including more lifetime manic and depressive symptoms, rapid cycling illness, comorbid mental disorders, substance abuse and active illness.…”