Course of Psychiatric and Substance Abuse Syndromes Co-Occurring With Bipolar Disorder After a First Psychiatric Hospitalization
J Clin Psychiatry 1998;59:465-471
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Patients with bipolar disorder frequently meet criteria for
other psychiatric and substance abuse diagnoses. To clarify relationships among these
disorders, the authors examined the course of syndromes co-occurring with bipolar disorder
for 12 months after a first hospitalization.
Method: Seventy-seven patients were recruited from consecutive inpatient
admissions who met DSM-III-R criteria for bipolar disorder, manic or mixed with psychosis.
The 12-month syndromal course of co-occurring DSM-III-R alcohol and drug abuse disorders,
posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and other
anxiety disorders were longitudinally recorded.
Results: The rates of all syndromes, except other anxiety disorders, were
elevated. OCD demonstrated an interval course that frequently mirrored the course of the
bipolar disorder. The courses of PTSD and substance abuse syndromes were separate from
that of the bipolar disorder in many of those with both syndromes. Alcohol and drug abuse
syndromes were strongly correlated.
Conclusion: The obsessive-compulsive syndrome may represent an
alternative expression of bipolar disorder in some patients. In contrast, PTSD appears to
represent a truly separate disorder, which is possibly more prevalent in bipolar patients
due to a shared risk factor. Substance abuse does not appear to simply result from
attempts at self-medication or from the impulsivity of mania. These results suggest that
future studies examining the course of syndromes co-occurring with bipolar disorder are