MedWire News: Adolescent bipolar disorder is a significant risk factor for substance use disorders and cigarette smoking, regardless of psychiatric comorbidity, say scientists who recommend careful screening of such patients.
Previous research has indicated that bipolar disorder during adolescence increases the risk for substance use disorders and cigarette smoking, but only a limited number of studies have examined the link, explain the researchers.
Timothy Wilens, from Massachusetts General Hospital in Boston, USA, and colleagues therefore studied 105 adolescents with bipolar disorder, who had an average age of 13.6 years, and 98 individuals without the disorder, who had an average age of 13.7 years.
Participants aged less than 18 years were assessed for rates of substance use and other disorders using the DSM-IV Kiddie Schedule for Affective Disorders-Epidemiologic Version, while those aged 18 years were administered the Structured Clinical Interview for DSM-IV. In addition, the Hollingshead Four-Factor Index of socioeconomic status and the Social Adjustment Inventory for Children and Adolescents were used.
Analysis revealed that bipolar disorder patients had a significantly increased age-adjusted risk for any substance use disorder in comparison with controls, at 34% versus 4% and a hazard ratio of 8.68, the team reports in the journal Drug and Alcohol Dependence.
Bipolar disorder patients also had, in comparison with controls, a significantly increased risk for alcohol abuse (23% vs 3%, hazard ratio [HR]=7.66), drug abuse (22% vs 1%, HR=18.5), drug dependence (14% vs 1%, HR=12.1), and cigarette smoking (22% vs 4%, HR=12.3).
These associations were found to be independent of attention deficit/hyperactivity disorder, multiple anxiety, and conduct disorder. Logistic regression indicated that the primary predictor of substance use disorder in bipolar adolescents was increasing age.
Dr Wilens commented: "It could be that the onset of mood dysregulation in adolescence puts kids at even higher risk for poor judgement and self-medication of their symptoms. It could also be that some genetic switch activated in adolescence turn on both bipolar disorder and substance abuse in these youngsters."
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