Course of Psychiatric and Substance Abuse Syndromes Co-Occurring With Bipolar Disorder After a First Psychiatric Hospitalization

Background: Patients with bipolar disorder frequently meet criteria forother psychiatric and substance abuse diagnoses. To clarify relationships among thesedisorders, the authors examined the course of syndromes co-occurring with bipolar disorderfor 12 months after a first hospitalization.

Method: Seventy-seven patients were recruited from consecutive inpatientadmissions 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 otheranxiety disorders were longitudinally recorded.

Results: The rates of all syndromes, except other anxiety disorders, wereelevated. OCD demonstrated an interval course that frequently mirrored the course of thebipolar disorder. The courses of PTSD and substance abuse syndromes were separate fromthat of the bipolar disorder in many of those with both syndromes. Alcohol and drug abusesyndromes were strongly correlated.

Conclusion: The obsessive-compulsive syndrome may represent analternative expression of bipolar disorder in some patients. In contrast, PTSD appears torepresent a truly separate disorder, which is possibly more prevalent in bipolar patientsdue to a shared risk factor. Substance abuse does not appear to simply result fromattempts at self-medication or from the impulsivity of mania. These results suggest thatfuture studies examining the course of syndromes co-occurring with bipolar disorder arewarranted.