Clinical Correlates of Patients With Rapid-Cycling Bipolar Disorder and a Recent History of Substance Use Disorder: A Subtype Comparison From Baseline Data of 2 Randomized, Placebo-Controlled Trials
J Clin Psychiatry 2008;69(7):1057-1063
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: To compare clinical variables in
patients with rapid-cycling bipolar I or II disorder
and a recent history of substance use disorder (SUD).
Method: Cross-sectional data from 2 studies
of patients with rapid-cycling bipolar I disorder
or rapid-cycling bipolar II disorder and a recent
history of SUD were used to retrospectively assess
the differences in clinical variables between the
subtypes. The studies were conducted from November 1997 to February 2007 at University
Hospitals Case Medical Center, Case Western Reserve
University School of Medicine, Cleveland, Ohio. Extensive clinical interview and the
Mini-International Neuropsychiatric Interview were used
to ascertain DSM-IV diagnoses of rapid-cycling bipolar disorder, SUDs, and other Axis I
disorders and to collect clinical variables. The Addiction
Severity Index (ASI), Global Assessment Scale (GAS), and the Medical Outcomes Study
36-Item Short-Form Health Survey were used to
measure the severity of impairment at the initial
assessment. One-way analysis of variance or
chi2 was used for significance tests. A Bonferroni adjustment
was applied for multiple comparisons.
Results: Of 245 patients with rapid-cycling
bipolar disorder (rapid-cycling bipolar I disorder, N
= 191; rapid-cycling bipolar II disorder, N = 54)
and a recent history of SUD, the demographics were similar. A significantly higher rate of panic
disorder was observed in patients with rapid-cycling
bipolar I disorder than in those with rapid-cycling
bipolar II disorder (odds ratio = 3.72, 95% CI = 1.66
to 8.32, p = .008). A significantly higher
psychiatric composite score on the ASI was also found in
patients with rapid-cycling bipolar I disorder than
in those with rapid-cycling bipolar II disorder
even after Bonferroni adjustment (p = .0007).
There were no significant differences between the
subtypes in the rates of previous hospitalization or
suicide attempt, early childhood verbal, physical,
or sexual abuse, lifetime substance abuse or dependence, the number of SUDs or mood episodes
in the last 12 months, and total or other subscale scores on ASI and GAS.
Conclusion: Except for the significantly
higher rate of comorbid panic disorder and higher
psychiatric composite scores on the ASI in patients
with rapid-cycling bipolar I disorder than in those
with rapid-cycling bipolar II disorder, the other
clinical variables were similar between the 2 groups.
Trial Registration: clinicaltrials.gov Identifiers: NCT00194129 and NCT00221975