Treatment Delay and Excessive Substance Use in Bipolar Disorder

Abstract

The aim of the present study was to investigate the relationship between treatment delay and excessive substance use. A total of 151 bipolar disorder (BD) I and II patients were consecutively recruited from in- and outpatient psychiatric units, and categorized as primary or secondary BD (without or with antecedent excessive substance use). Predictors of treatment delay among all patients, and predictors of subsequent excessive substance use among primary BD patients, were investigated with logistic regression analyses. The median treatment delay was 2.0 years (IQR 14.0). The risk of long treatment delays was increased in patients with BD II disorder, no lifetime psychosis, a higher age at first contact with specialized psychiatric services, primary BD, and excessive substance use. In primary BD, the risk for developing excessive substance use was increased in males, in patients with shorter education and longer treatment delays. Patients with antecedent excessive substance use had reduced risk of long treatment delays. The risk of developing excessive substance use after BD onset increased with longer treatment delays.

Stigma- and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers

“…Duration of untreated illness is also associated with worse outcomes in affective disorders (Dell'Osso et al, 2013). For example, lengthy treatment delays for those with bipolar disorder can increase the risk of substance misuse (Lagerberg et al, 2010) and attempts at suicide (Nery-Fernandes et al, 2012).…”

Trastorno bipolar y trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patología dual

“…Dicha concurrencia es habitual como señalan importantes estudios epidemiológi-cos en población general (Kessler, Nelson, McGonagle, Edlund, Frank y Leaf, 1996;Regier et al, 1990), e igualmente en muestras clínicas (Weaver et al, 2003). La comorbilidad modifica la presentación clínica y el curso evolutivo, repercute en el abordaje terapéutico al existir menos evidencia científica sobre el tratamiento más adecuado, además de relacionarse con una menor adherencia al tratamiento, un mayor uso de servicios sanitarios y mayor discapacidad funcional (González-Pinto et al, 2006;González-Pinto, Reed, Novick, Bertsch y Haro, 2010;Lagerberg et al, 2010).…”

The clinical management of bipolar disorder complexity using a stratified model

“…Ultimately, it lowers the quality of life (10) and social functioning (135), and increases disability, suicidal behaviour, and mortality (10,(136)(137)(138). Phenomenologically, substance abuse comorbidity can mirror and mask the symptoms of BD (139) and this no doubt contributes to the greater likelihood of treatment delay (140), undertreatment, and inappropriate medication in this complex comorbidity, particularly among BD-I patients (132).…”