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Alcohol misuse in bipolar disorder. A systematic review and meta-analysis of comorbidity rates

Published online by Cambridge University Press:  15 April 2020

A. Di Florio ,
N. Craddock  and
M. van den Bree
A. Di Florio*
Affiliation:
Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, United Kingdom
N. Craddock
Affiliation:
Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, United Kingdom
M. van den Bree
Affiliation:
Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, United Kingdom
*
*Corresponding author. Tel.: +44 2920 744 826. E-mail address: DiFlorioA@cf.ac.uk (A. Di Florio).
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Abstract

Aims:

To assess the comorbidity rates of alcohol use disorders (AUDs) in bipolar disorder (BD) and to explore possible sources of heterogeneity.

Methods:

Studies were identified through database searches. Meta-analytic techniques were employed to aggregate data on lifetime comorbidity and to explore possible sources of heterogeneity. Funnel plots were used to detect publication bias.

Results:

In clinical studies, AUDs affected more than one in three subjects with BD. Significant heterogeneity was found, which was largely explained by the geographical location of study populations and gender ratio of participants. AUDs affected more than one in five women and two in five men.

Conclusion:

AUDs are highly prevalent in BD. Our study revealed a substantial heterogeneity across studies. Further research including control groups is needed. Patients with BD should be assessed for current and previous AUDs.

Keywords

Alcohol use disordersBipolar disorderComorbidityCo-occurrence

Information

Type
Review
Information
European Psychiatry , Volume 29 , Issue 3 , March 2014 , pp. 117 - 124
Copyright
Copyright © European Psychiatric Association 2014

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References

Agarwal, DP, Goedde, HWPharmacogenetics of alcohol metabolism and alcoholism. Pharmacogenetics 1992;2(2):48–62.CrossRefGoogle ScholarPubMed
Angst, JThe emerging epidemiology of hypomania and bipolar II disorder. J Affect Disord 1998;50(2–3):143–151.CrossRefGoogle ScholarPubMed
Bizzarri, JV, Sbrana, A, Rucci, P, Ravani, L, Massei, GJ, Gonnelli, Cet al.The spectrum of substance abuse in bipolar disorder: reasons for use, sensation seeking and substance sensitivity. Bipolar Disord 2007;9(3):213–220.CrossRefGoogle ScholarPubMed
Brown, GR, McBride, L, Bauer, MS, Williford, WOImpact of childhood abuse on the course of bipolar disorder: a replication study in U.S. veterans. J Affect Disord 2005;89(1–3):57–67.CrossRefGoogle ScholarPubMed
Cardoso, BM, Kauer Sant’Anna, M, Dias, VV, Andreazza, AC, Ceresér, KM, Kapczinski, FThe impact of co-morbid alcohol use disorder in bipolar patients. Alcohol 2008;42(6):451–457.CrossRefGoogle ScholarPubMed
Cassidy, F, Ahearn, EP, Carroll, BJSubstance abuse in bipolar disorder. Bipolar Disord 2001;3(4):181–188.CrossRefGoogle ScholarPubMed
Castilla-Puentes, RC, Secin, R, Grau, A, Galeno, R, De Mello, .F., Castilla-Puentes, Set al.A multicenter study of bipolar disorder among emergency department patients in Latin-American countries. Int J Psychiatry Med 2011;42(1):49–67.CrossRefGoogle ScholarPubMed
Cha, B, Moon, ES, Jeong, CY, Ha, KAxis I psychiatric comorbidity in Korean patients with bipolar disorder: Prevalence and response to treatment. Journal of Cancer Education [Internet]. 2009 [cited 2012 Apr 16]; Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70044745.Google Scholar
Chengappa, KN, Levine, J, Gershon, S, Kupfer, DJLifetime prevalence of substance or alcohol abuse and dependence among subjects with bipolar I and II disorders in a voluntary registry. Bipolar Disord 2000;2(3 Pt 1):191–195.CrossRefGoogle ScholarPubMed
Chou, SP, Lee, HK, Cho, MJ, Park, JI, Dawson, DA, Grant, BFAlcohol use disorders, nicotine dependence, and co-occurring mood and anxiety disorders in the United States and South Korea – a cross-national comparison. Alcohol Clin Exp Res 2012;36(4):654–662.CrossRefGoogle ScholarPubMed
Craddock, N, Kendler, K, Neale, M, Nurnberger, J, Purcell, S, Rietschel, Met al.Dissecting the phenotype in genome-wide association studies of psychiatric illness. Br J Psychiatry 2009;195(2):97–99.Google ScholarPubMed
Dalton, EJ, Cate-Carter, TD, Mundo, E, Parikh, SV, Kennedy, JLSuicide risk in bipolar patients: the role of co-morbid substance use disorders. Bipolar Disord 2003;5(1):58–61.CrossRefGoogle ScholarPubMed
Dawson, NV, Dadheech, G, Speroff, T, Smith, RL, Schubert, DSThe effect of patient gender on the prevalence and recognition of alcoholism on a general medicine inpatient service. J Gen Intern Med 1992;7(1):38–45.CrossRefGoogle ScholarPubMed
Egger, M, Schneider, M, Davey Smith, GSpurious precision? Meta-analysis of observational studies. BMJ 1998;316(7125):140–144.CrossRefGoogle ScholarPubMed
Escamilla, MA, Batki, S, Reus, VI, Spesny, M, Molina, J, Service, Set al.Comorbidity of bipolar disorder and substance abuse in Costa Rica: pedigree- and population-based studies. J Affect Disord 2002;71(1–3):71–83.CrossRefGoogle ScholarPubMed
Escobar, JI, Vega, WACultural issues and psychiatric diagnosis: providing a general background for considering substance use diagnoses. Addiction 2006;101(Suppl. 1):40–47.CrossRefGoogle ScholarPubMed
Fogarty, F, Russell, J, Newman, S, Bland, RMania. Acta Psychiatr Scand Suppl 1994;376:16–23.CrossRefGoogle ScholarPubMed
Frank, E, Boland, E, Novick, DM, Bizzarri, JV, Rucci, PAssociation between illicit drug and alcohol use and first manic episode. Pharmacol Biochem Behav 2007;86(2):395–400.CrossRefGoogle ScholarPubMed
Frye, MA, Altshuler, LL, McElroy, SL, Suppes, T, Keck, PE, Denicoff, Ket al.Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder. Am J Psychiatry 2003;160(5):883–889.CrossRefGoogle ScholarPubMed
Glantz, MD, Anthony, JC, Berglund, PA, Degenhardt, L, Dierker, L, Kalaydjian, Aet al.Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits. Psychol Med 2009;39(8):1365–1377.CrossRefGoogle ScholarPubMed
Glasser, SP, Duval, SEssentials of Clinical Research. Springer Netherlands; 2008 [cited 2012 Mar 26]. p. 159–77. Available from: http://www.springerlink.com.abc.cardiff.ac.uk/content/k531021571444176/abstract/.CrossRefGoogle Scholar
Goldberg, JF, Garno, JL, Leon, AC, Kocsis, JH, Portera, LA history of substance abuse complicates remission from acute mania in bipolar disorder. J Clin Psychiatry 1999;60(11):733–740.CrossRefGoogle ScholarPubMed
Goldstein, BI, Levitt, AJFactors associated with temporal priority in comorbid bipolar I disorder and alcohol use disorders: Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2006;67(4):643–649.CrossRefGoogle ScholarPubMed
González-Pinto, A, Alberich, S, Barbeito, S, Alonso, M, Vieta, E, Martínez-Arán, Aet al.Different profile of substance abuse in relation to predominant polarity in bipolar disorder: The Vitoria long-term follow-up study. J Affect Disord 2010;124(3):250–255.CrossRefGoogle ScholarPubMed
Grant, BF, Stinson, FS, Hasin, DS, Dawson, DA, Chou, SP, Ruan, WJet al.Prevalence, correlates, and comorbidity of bipolar I disorder and axis I and II disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2005;66(10):1205–1215.CrossRefGoogle ScholarPubMed
Grant, BF, Goldstein, RB, Chou, SP, Huang, B, Stinson, FS, Dawson, DAet al.Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Mol Psychiatry 2009;14(11):1051–1066.CrossRefGoogle ScholarPubMed
Hasin, D, Hatzenbuehler, ML, Keyes, K, Ogburn, ESubstance use disorders: Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and International Classification of Diseases, tenth edition (ICD-10). Addiction 2006;101(Suppl. 1):59–75.CrossRefGoogle Scholar
Hendrick, V, Altshuler, LL, Gitlin, MJ, Delrahim, S, Hammen, CGender and bipolar illness. J Clin Psychiatry 2000;61(5):393–396 quiz 397.CrossRefGoogle ScholarPubMed
Higgins, JPTMeasuring inconsistency in meta-analyses. BMJ 2003;327(7414):557–560.CrossRefGoogle ScholarPubMed
Higgins, JP, Whitehead, A, Turner, RM, Omar, RZ, Thompson, SGMeta-analysis of continuous outcome data from individual patients. Stat Med 2001;20(15):2219–2241.CrossRefGoogle ScholarPubMed
Hoertel, N, Le Strat, Y, Lavaud, P, Dubertret, C, Limosin, FGeneralizability of clinical trial results for bipolar disorder to community samples: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2013;74(3):265–270.CrossRefGoogle ScholarPubMed
Kawa, I, Carter, JD, Joyce, PR, Doughty, CJ, Framtpon, CM, Wells, JEet al.Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation. Bipolar Disord 2005;7(2):119–125.CrossRefGoogle ScholarPubMed
Keck, PE, McElroy, SL, Strakowski, SM, West, SA, Sax, KW, Hawkins, JMet al.12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. AJP 1998;155(5):646–652.CrossRefGoogle ScholarPubMed
Kessler, R, Crum, R, Warner, L, Nelson, Cet al.Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997;54(4):313–321.CrossRefGoogle ScholarPubMed
Knapp, G, Hartung, JImproved tests for a random effects meta-regression with a single covariate. Stat Med 2003;22(17):2693–2710.CrossRefGoogle ScholarPubMed
Kraepelin, EManic-depressive insanity and paranoia [Internet]. [cited 2012 May 11]. Available from: http://archive.org/details/manicdepressivei00kraeuoft.Google Scholar
Le-Niculescu, H, McFarland, MJ, Ogden, CA, Balaraman, Y, Patel, S, Tan, Jet al.Phenomic, convergent functional genomic, and biomarker studies in a stress-reactive genetic animal model of bipolar disorder and co-morbid alcoholism. Am J Med Genet B Neuropsychiatr Genet 2008;147B(2):134–166.CrossRefGoogle Scholar
Levander, E, Frye, MA, McElroy, S, Suppes, T, Grunze, H, Nolen, WAet al.Alcoholism and anxiety in bipolar illness: differential lifetime anxiety comorbidity in bipolar I women with and without alcoholism. J Affect Disord 2007;101(1–3):211–217.CrossRefGoogle ScholarPubMed
Lydall, GJ, Bass, NJ, McQuillin, A, Lawrence, J, Anjorin, A, Kandaswamy, Ret al.Confirmation of prior evidence of genetic susceptibility to alcoholism in a genome-wide association study of comorbid alcoholism and bipolar disorder. Psychiatr Genet 2011;21(6):294–306.CrossRefGoogle Scholar
Maier, W, Lichtermann, D, Minges, J, Delmo, C, Heun, RThe relationship between bipolar disorder and alcoholism: a controlled family study. Psychol Med 1995;25(4):787–796.CrossRefGoogle ScholarPubMed
Merikangas, KR, Herrell, R, Swendsen, J, Rössler, W, Ajdacic-Gross, V, Angst, JSpecificity of bipolar spectrum conditions in the comorbidity of mood and substance use disorders: results from the Zurich cohort study. Arch Gen Psychiatry 2008;65(1):47–52.CrossRefGoogle ScholarPubMed
Morgan, VA, Mitchell, PB, Jablensky, AVThe epidemiology of bipolar disorder: sociodemographic, disability and service utilization data from the Australian National Study of Low Prevalence (Psychotic) Disorders. Bipolar Disord 2005;7(4):326–337.CrossRefGoogle ScholarPubMed
Mueser, KT, Yarnold, PR, Rosenberg, SD, Swett, C. Jr.Miles, KM, Hill, DSubstance use disorder in hospitalized severely mentally ill psychiatric patients: prevalence, correlates, and subgroups. Schizophr Bull 2000;26(1):179–192.CrossRefGoogle ScholarPubMed
Nery, FG, Hatch, JP, Glahn, DC, Nicoletti, MA, Serap Monkul, E, Najt, Pet al.Temperament and character traits in patients with bipolar disorder and associations with comorbid alcoholism or anxiety disorders. J Psychiatr Res 2008;42(7):569–577.CrossRefGoogle ScholarPubMed
Neves, FS, Malloy-Diniz, LF, Corrêa, HSuicidal behavior in bipolar disorder: what is the influence of psychiatric comorbidities?. J Clin Psychiatry 2009;70(1):13–18.CrossRefGoogle ScholarPubMed
Nivoli, AMA, Pacchiarotti, I, Rosa, AR, Popovic, D, Murru, A, Valenti, Met al.Gender differences in a cohort study of 604 bipolar patients: the role of predominant polarity. J Affect Disord 2011;133(3):443–449.CrossRefGoogle Scholar
Öngür, D, Lin, L, Cohen, BMClinical characteristics influencing age at onset in psychotic disorders. Compr Psychiatry 2009;50(1):13–19.CrossRefGoogle ScholarPubMed
Ostacher, MJ, Nierenberg, AA, Perlis, RH, Eidelman, P, Borrelli, DJ, Tran, TBet al.The relationship between smoking and suicidal behavior, comorbidity, and course of illness in bipolar disorder. J Clin Psychiatry 2006;67(12):1907–1911.CrossRefGoogle ScholarPubMed
Ostacher, MJ, Perlis, RH, Nierenberg, AA, Calabrese, J, Stange, JP, Salloum, Iet al.Impact of substance use disorders on recovery from episodes of depression in bipolar disorder patients: prospective data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry 2010;167(3):289–297.CrossRefGoogle Scholar
Regier, DA, Farmer, ME, Rae, DS, Locke, BZ, Keith, SJ, Judd, LLet al.Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990;264(19):2511–2518.CrossRefGoogle ScholarPubMed
Saunders, EFH, Zhang, P, Copeland, JN, Mclnnis, MG, Zöllner, SSuggestive linkage at 9p22 in bipolar disorder weighted by alcohol abuse. Am J Med Genet B Neuropsychiatr Genet 2009;150B(8):1133–1138.CrossRefGoogle ScholarPubMed
Saunders, EFH, Fitzgerald, KD, Zhang, P, McInnis, MGClinical features of bipolar disorder comorbid with anxiety disorders differ between men and women. Depress Anxiety 2012;29(8):739–746.CrossRefGoogle ScholarPubMed
Schuckit, MAComorbidity between substance use disorders and psychiatric conditions. Addiction 2006;101(Suppl. 1):76–88.CrossRefGoogle ScholarPubMed
Soreca, I, Fagiolini, A, Frank, E, Houck, PR, Thompson, WK, Kupfer, DJRelationship of general medical burden, duration of illness and age in patients with bipolar I disorder. J Psychiatr Res 2008;42(11):956–961.CrossRefGoogle ScholarPubMed
Strakowski, SM, Sax, KW, McElroy, SL, Keck, P.E. Jr.Hawkins, JM, West, SACourse of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization. J Clin Psychiatry 1998;59(9):465–471.CrossRefGoogle ScholarPubMed
Strakowski, SM, DelBello, MP, Fleck, DE, Adler, CM, Anthenelli, RM, Keck, P.E. Jr.et al.Effects of co-occurring alcohol abuse on the course of bipolar disorder following a first hospitalization for mania. Arch Gen Psychiatry 2005;62(8):851–858.CrossRefGoogle ScholarPubMed
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, Det al.Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283(15):2008–2012.CrossRefGoogle ScholarPubMed
Suominen, K, Mantere, O, Valtonen, H, Arvilommi, P, Leppämäki, S, Isometsä, EGender differences in bipolar disorder type I and II. Acta Psychiatr Scand 2009;120(6):464–473.CrossRefGoogle ScholarPubMed
Suzanne, I, Fourquet, F, Degiovanni, A, Gaillard, PCourse and socio-familial outcome of bipolar mood disorders. Ann Med Psychol 2001 554–559.Google Scholar
Tsai, SY, Chen, CC, Yeh, EKAlcohol problems and long-term psychosocial outcome in Chinese patients with bipolar disorder. J Affect Disord 1997;46(2):143–150.CrossRefGoogle ScholarPubMed
Tsai, HC, Lu, MK, Yang, YK, Huang, MC, Yeh, TL, Chen, WJet al.Empirically derived subgroups of bipolar I patients with different comorbidity patterns of anxiety and substance use disorders in Han Chinese population. J Affect Disord 2012;136(1–2):81–89.CrossRefGoogle ScholarPubMed
Van Praag, HMComorbidity (psycho) analysed. Br J Psychiatry Suppl 1996;30:129–134.CrossRefGoogle Scholar
Van Roy, R, Van Den Eede, F, Peeters, K, Kenis, C, Sabbe, BGC, Claes, SJ[Comorbid anxiety disorders and alcohol-related disorders in a population of bipolar I disorder: investigation in a Flemish population]. Tijdschr Psychiatr 2010;52(2):69–78.Google Scholar
Viechtbauer, WConducting Meta-Analyses in R with the metafor Package. J Stat Softw 2010;36(3):1–48.CrossRefGoogle Scholar
Whitfield, JBAlcohol dehydrogenase and alcohol dependence: variation in genotype-associated risk between populations. Am J Hum Genet. 2002;71(5):1247–1250 [author reply 1250–1251].CrossRefGoogle ScholarPubMed
Winokur, G, Coryell, W, Akiskal, HS, Endicott, J, Keller, M, Mueller, TManic-depressive (bipolar) disorder: the course in light of a prospective ten-year follow-up of 131 patients. Acta Psychiatr Scand 1994;89(2):102–110.CrossRefGoogle ScholarPubMed
Winokur, G, Turvey, C, Akiskal, H, Coryell, W, Solomon, D, Leon, Aet al.Alcoholism and drug abuse in three groups – bipolar I, unipolars and their acquaintances. J Affect Disord 1998;50(2–3):81–89.CrossRefGoogle ScholarPubMed
Wittchen, HUWhat is comorbidity – fact or artefact?. Br J Psychiatry Suppl 1996;30:7–8.CrossRefGoogle Scholar
Wittchen, HUCritical issues in the evaluation of comorbidity of psychiatric disorders. Br J Psychiatry Suppl 1996;30:9–16.CrossRefGoogle Scholar
World Health Organization (WHO) [Internet]. WHO. [cited 2012 May 11]. Available from: http://www.who.int/substance_abuse/publications/global_alcohol_report/en/index.html.Google Scholar
Zakhari, S, Hunt, WAStress, Gender and Alcohol-Seeking Behavior. Darby, PA, USA: DIANE Publishing; 1996.Google Scholar
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