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Bipolar disorder and substance use: Risk factors and prognosis

Published online by Cambridge University Press:  19 July 2023

M. Fernández Lozano*
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
B. Rodríguez Rodríguez
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
M. J. Mateos Sexmero
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
N. Navarro Barriga
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
C. Vallecillo Adame
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
C. de Andrés Lobo
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
T. Jimenez Aparicio
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
M. Queipo de Llano de la Viuda
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
G. Guerra Valera
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
A. A. Gonzaga Ramírez
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
M. P. Pando Fernández
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
M. Calvo Valcárcel
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
M. A. Andreo Vidal
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
P. Martínez Gimeno
Affiliation:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
*
*Corresponding author.

Abstract

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Introduction

Bipolar disorder comorbidity rates are the highest among the major mental disorders. In addition to other intoxicants, alcohol is the most abused substance because it is socially accepted and can be legally bought and consumed. Estimates are between 40-70% with male predominance, which further influences the severity with a more complicated course of both disorders.

Objectives

The objective of this article is to highlight the impact of substance use on the course and prognosis of bipolar disorder, as well as to make a differential diagnosis of a manic episode in this context.

Methods

Bibliographic review of scientific literature based on a relevant clinical case.

Results

We present the case of a 45-year-old male patient. Single with no children. Unemployed. History of drug use since he was young: alcohol, cannabis and amphetamines. Diagnosed with bipolar disorder in 2012 after a manic episode that required hospital admission. During his evolution he presented two depressive episodes that required psychopharmacological treatment and follow-up by his psychiatrist of reference. Since then, he has been consuming alcohol and amphetamines occasionally, with a gradual increase until it became daily in the last month. He went to the emergency department for psychomotor agitation after being found in the street. He reported feeling threatened by a racial group presenting accelerated speech, insomnia and increased activity.

Conclusions

The presence of substance abuse complicates the clinical presentation, treatment and development of bipolar disorder. It is associated with a worse prognosis with multiple negative consequences including worsening symptom severity, increased risk of suicide and hospitalization, increased medical morbidity and complication of social problems. In addition, this comorbidity delays both the diagnosis and treatment, by masking the symptoms, and making more difficult an adequate differential diagnosis.

Disclosure of Interest

None Declared

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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